Carcinoma Lung Presenting with Skeletal Muscle Metastasis: Case Report with Review of Literature

Lung cancers usually present very late with distant metastasis, thereby carrying a poor prognosis. Metastasis at unusual sites such as extremity musculature does create a diagnostic challenge. This leads to delay in diagnosis and treatment initiation and further worsens the prognosis of the patient. Not many cases have been reported as of now and no standard guidelines are available regarding clinical approach in such cases. We have presented one of such cases to emphasize on importance of early detection and differentiation of such lesions from primary soft tissue malignancies.

Isolated brachioradialis metastasis of gastric adenocarcinoma after R0 resection

BackgroundGastric cancer is the fifth most common cancer worldwide, with an incidence of 6.72 per 100,000 people. Thirty-two percent of gastric cancer patients will live 5 years after diagnosis. Single-site metastasis is noted in 26% of patients with gastric cancer, most commonly in the liver (48%), peritoneum (32%), lung (15%), and bone (12%). Here, a case is presented in which a single skeletal muscle metastasis appeared after appropriate resection and treatment.Case presentationA 63-year-old man underwent neoadjuvant chemotherapy and a multivisceral en bloc R0 resection. Final pathology showed no evidence of lymph node metastasis with 31 negative lymph nodes. Four months postoperatively, the patient was found to have a rapidly growing biopsy-proven extremity soft tissue gastric metastasis within the brachioradialis muscle. He subsequently underwent metastasectomy and immunotherapy.ConclusionThis case is a rare example of an isolated extremity metastasis of gastric adenocarcinoma in the setting of an R0 resection of the primary tumor and negative nodal disease on final pathology, suggestive of hematogenous spread. We review the biology, workup, and management of gastric cancer and highlight new advancements in the treatment of this aggressive cancer.