Roslly Mohd Zulkimi, Mustapha Aida Widure Mustapha Mohd, Zainal Isa Azzaki
Department of Radiology, Faculty of Medicine, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Radiol Case Rep. 2021 Jun 9;16(8):2099-2102. doi: 10.1016/j.radcr.2021.04.069. eCollection 2021 Aug.
Urinary bladder carcinoma is a common malignancy worldwide. The metastatic disease to distant organs including lung, liver, and bone is well established. However, metastasis to below-knee-level; also known as acrometastasis is a rare occurrence and occurs approximately 0.1% of all bone metastases. It is standard of care to obtain a contrast enhanced computed tomography scan of the chest, abdomen, and pelvis for pretreatment planning, primary staging, and post treatment disease surveillance. This makes the occurrence of acrometastasis harder to detect and may only manifest clinically in advance disease. We report a case of 55 years old gentleman treated as muscle-invasive bladder urothelial carcinoma, presented with chronic left knee pain, and imaging demonstrating tumor in the left knee region. Histopathologic study shows features of metastatic disease from urinary bladder carcinoma to the left gastrocnemius muscle. The attending physician should raise the suspicion of metastatic disease if the patient with known malignancy presented with new soft tissue lesion elsewhere in the body.
膀胱癌是全球常见的恶性肿瘤。其转移至包括肺、肝和骨在内的远处器官已得到充分证实。然而，转移至膝下水平，也称为肢端转移，是一种罕见情况，约占所有骨转移的0.1%。在进行预处理规划、初始分期和治疗后疾病监测时，进行胸部、腹部和骨盆的对比增强计算机断层扫描是标准的治疗流程。这使得肢端转移的发生更难被检测到，并且可能仅在疾病晚期才在临床上表现出来。我们报告一例55岁男性，被诊断为肌肉浸润性膀胱尿路上皮癌，出现慢性左膝疼痛，影像学检查显示左膝区域有肿瘤。组织病理学研究显示有膀胱癌转移至左腓肠肌的特征。如果已知患有恶性肿瘤的患者身体其他部位出现新的软组织病变，主治医生应怀疑有转移疾病。
