Soker Gokhan, Soker Eda, Gulek Bozkurt, Acikalin Arbil, Asut Elife, Kaya Omer, Dilek Okan, Yilmaz Cengiz
Department of Radiology, Numune Training and Research Hospital, Adana, Turkey.
Department of Physical Therapy and Rehabilitation, Numune Training and Research Hospital, Adana, Turkey.
N Am J Med Sci. 2014 Dec;6(12):653-6. doi: 10.4103/1947-2714.147988.
Distant metastases of primary malignancies to the skeletal muscle tissue are a very rare event. Distant metastases that affect the rotator cuff are even rarer, and only a few of cases have been reported so far.
The present article reports two cases that presented to our hospital with the complaint of shoulder pain and had a soft tissue mass affecting the muscles of the rotator cuff and invading the neighboring bone compartments. One of the patients developed mucoepidermoid cancer metastasis of the submandibular gland, and the other was found to have a malignant epithelial tumor metastasized from the lower lobe of the right lung, whose primary origin could not be diagnosed until the imaging examinations were employed. Ultrasound and magnetic resonance imaging findings are presented in this paper.
Metastases to the muscle tissues could be misdiagnosed as primary sarcomas. Because the therapy regiments and prognoses are fairly different for these two entities, the possibility of a metastasis to the muscle tissue must be considered as a differential diagnosis for case of painful soft tissue mass. Ultrasound is very useful in detection of the lesion and acts as a very important tool during guidance for biopsy. Magnetic resonance imaging, however, is a very valuable asset in the evaluation of the borders of the soft tissue mass and its invasive effect on the bony tissues. Particularly when the features such as lobulated contours, peripheral edema, and intratumoral necrosis exist, the possibility of metastases must be considered.
原发性恶性肿瘤远处转移至骨骼肌组织是非常罕见的情况。影响肩袖的远处转移更为罕见，迄今为止仅有少数病例报道。
本文报告了两例因肩部疼痛前来我院就诊的病例，均有软组织肿块，累及肩袖肌肉并侵犯邻近骨腔。其中一例患者为下颌下腺黏液表皮样癌转移，另一例患者被发现是右肺下叶转移的恶性上皮性肿瘤，在采用影像学检查之前无法诊断其原发灶。本文展示了超声和磁共振成像的检查结果。
肌肉组织转移可能被误诊为原发性肉瘤。由于这两种疾病的治疗方案和预后有很大差异，对于有疼痛性软组织肿块的病例，必须考虑肌肉组织转移的可能性作为鉴别诊断。超声在检测病变方面非常有用，并且在活检引导过程中是非常重要的工具。然而，磁共振成像在评估软组织肿块的边界及其对骨组织的侵袭作用方面是非常有价值的。特别是当存在分叶状轮廓、周边水肿和瘤内坏死等特征时，必须考虑转移的可能性。
