Maréchal E, Rivat P, Leclercq R
Centre Claude-Bernard, 226, boulevard Charles-de-Gaulle, 07500 Guilherand-Granges.
Rev Chir Orthop Reparatrice Appar Mot. 2001 Feb 1;87(1):79-83.
Malignant metastases are rarely located in skeletal muscles. We report a case of lung adenocarcinoma disclosed by metastatic dissemination to the infraspinatus muscle.
A 66-year-old man consulted for a painful stiff right shoulder. Pain had developed progressively and did not respond to class 2 antalgesics. There was a complete loss of passive and active medial rotation while the other shoulder amplitudes were normal. A discrete tumefaction was palpated in the infraspinatus fossa. Magnetic resonance imaging alone was able to evidence an intramuscular tumoral formation within the infraspinatus. Surgical excision led to the diagnosis of metastatic adenocarcinoma of the lung and provided rapid pain relief. Nearly normal medial rotation amplitude was recovered. The patient died at 10 months from complications related to the lung adenocarcinoma.
This is the first report of metastatic lung carcinoma located in the infraspinatus muscle. The clinical presentation was very exceptional, no similar cases being reported in the literature. In bloc surgical resection appears to be the best therapeutic approach, allowing positive diagnosis and relief of pain and stiffness.
恶性转移瘤很少位于骨骼肌。我们报告一例因转移至冈下肌而被发现的肺腺癌病例。
一名66岁男性因右肩部疼痛僵硬前来就诊。疼痛逐渐加重，对2级镇痛药无反应。患侧肩部被动和主动内旋完全丧失，而另一侧肩部活动幅度正常。在冈下窝可触及一个小肿块。仅磁共振成像就能够显示冈下肌内的肌内肿瘤形成。手术切除后诊断为肺转移性腺癌，并迅速缓解了疼痛。几乎恢复了正常的内旋幅度。患者在10个月时死于与肺腺癌相关的并发症。
这是首例位于冈下肌的转移性肺癌报告。临床表现非常罕见，文献中未报道过类似病例。整块手术切除似乎是最佳治疗方法，既能明确诊断，又能缓解疼痛和僵硬。
