Advertisement

European Radiology

, Volume 20, Issue 3, pp 649–658 | Cite as

Skeletal muscle metastases: primary tumours, prevalence, and radiological features

  • Alexey SurovEmail author
  • Michael Hainz
  • Hans-Jürgen Holzhausen
  • Dirk Arnold
  • Michaela Katzer
  • Joerg Schmidt
  • Rolf Peter Spielmann
  • Curd Behrmann
Musculoskeletal

Abstract

Background

Although skeletal muscles comprise nearly 50% of the total human body mass and are well vascularised, metastases in the musculature are rare. The reported prevalence of skeletal muscle metastases from post-mortem studies of patients with cancer is inconstant and ranges from 0.03 to 17.5%.

Materials and methods

Of 5,170 patients with metastasised cancer examined and treated at our institution during the period from January 2000 to December 2007, 61 patients with muscle metastases (80 lesions) were identified on computed tomography (CT). Genital tumours (24.6%) were the most frequent malignancies metastasising into the skeletal musculature, followed by gastrointestinal tumours (21.3%), urological tumours (16.4%), and malignant melanoma (13.1%). Other primary malignancies were rarer, including bronchial carcinoma (8.2%), thyroid gland carcinoma (4.9%), and breast carcinoma (3.3%). In 8.2%, carcinoma of unknown primary was diagnosed.

Results

Skeletal muscle metastases (SMM) were located in the iliopsoas muscle (27.5%), paravertebral muscles (25%), gluteal muscles (16.3%), lower extremity muscles (12.5%), abdominal wall muscles (10%), thoracic wall muscles (5%), and upper extremity muscles (3.8%). Most (76.3%) of the 80 SMM were diagnosed incidentally during routine staging CT examinations, while 23.7% were symptomatic.

Conclusion

Radiologically, SMM presented with five different types of lesions: focal intramuscular masses (type I, 52.5% of SMM), abscess-like intramuscular lesions (type II, 32.5%), diffuse metastatic muscle infiltration (type III, 8.8%), multifocal intramuscular calcification (type IV, 3.7%) and intramuscular bleeding (type V, 2.5%).

Keywords

Skeletal muscle metastases Prevalence CT imaging 

Notes

Acknowledgments

We thank Edith Disputh for the careful preparation of the manuscript.

References

  1. 1.
    Hasegawa S, Sakurai Y, Imazu H, Matsubara T, Ochiai M, Funabiki T, Suzuki K, Mizoguchi Y, Kuroda M, Kasahara M (2000) Metastasis to the forearm skeletal muscle from an adenocarcinoma of the colon: report of a case. Surg Today 30:1118–1123CrossRefPubMedGoogle Scholar
  2. 2.
    Willis RA (1952) The spread of tumours in the human body. Butterworth, LondonGoogle Scholar
  3. 3.
    Nabeyama R, Tanaka K, Matsuda S, Iwamoto Y (2001) Multiple intramuscular metastases 15 years after radical nephrectomy in a patient with stage IV renal cell carcinoma. J Orthop Sci 6:189–192CrossRefPubMedGoogle Scholar
  4. 4.
    Pearson C (1969) Incidence and type of pathologic alterations observed in muscle in a routine survey. Neurology 9:757–766Google Scholar
  5. 5.
    Acinas Garcia O, Fernandez FA, Satue EG, Buelta L, Val-Bernal JF (1984) Metastasis of malignant neoplasms to skeletal muscle. Rev Esp Oncol 31:57–67PubMedGoogle Scholar
  6. 6.
    Glockner DM, White LM, Sundaram M, McDonald DJ (2000) Unsuspected metastases presenting as solitary soft tissue lesions: a fourteen-year review. Skeletal Radiol 29:270–274CrossRefPubMedGoogle Scholar
  7. 7.
    Herring C, Harrelson J, Scully S (1998) Metastatic carcinoma to skeletal muscle. Clin Orthop Rel Res 355:272–281CrossRefGoogle Scholar
  8. 8.
    Koike Y, Hatori M, Kokubun S (2005) Skeletal muscle metastasis secondary to cancer–a report of seven cases. Ups J Med Sci 110:75–83CrossRefPubMedGoogle Scholar
  9. 9.
    Pretorius ES, Fishman EK (1999) Helical CT of skeletal muscle metastases from primary carcinomas. AJR Am J Roentgenol 174:401–404Google Scholar
  10. 10.
    Nabi G, Gupta NP, Gandhi D (2003) Skeletal muscle metastasis from transitional cell carcinoma of the urinary bladder: clinicoradiological features. Clin Radiol 58:883–885CrossRefPubMedGoogle Scholar
  11. 11.
    Magee T, Rosenthal H (2002) Skeletal muscle metastases at sites of documented trauma. AJR Am J Roentgenol 178:985–988PubMedGoogle Scholar
  12. 12.
    Damron T, Heiner J (2000) Distant soft tissue metastases: a series of 30 new patients and 91 cases from the literature. Ann Surg Oncol 7:526–534CrossRefPubMedGoogle Scholar
  13. 13.
    Tuoheti Y, Okada K, osanai T, Nishida J, Ehara S, Hashimoto M, Itoi E (2004) Skeletal muscle metastases of carcinomas: a clinicopathological study of 12 cases. Jpn J Clin Oncol 34:210–214CrossRefPubMedGoogle Scholar
  14. 14.
    Nguyen NC, Chaar BT, Osman MM (2007) Prevalence and patterns of soft tissue metastasis: detection with true whole-body FDG PET/CT. BMC Med Imaging 7:8CrossRefPubMedGoogle Scholar
  15. 15.
    Schmidt GP, Reiser M (2007) Whole-body imaging of the musculoskeletal system: the value of MR imaging. Skeletal Radiol 36:1109–1119CrossRefPubMedGoogle Scholar
  16. 16.
    Sridhar KS, Rao RK, Kunhardt B (1987) Skeletal muscle metastases from lung cancer. Cancer 59:1530–1534CrossRefPubMedGoogle Scholar
  17. 17.
    Djaldetti M, Sredni B, Zigelman R, Verber M, Fishman P (1996) Muscle cells produce a low molecular weight factor with anti-cancer activity. Clin Exp Metastasis 14:189–196PubMedGoogle Scholar
  18. 18.
    Kurek J, Nouri S, Kannourakis G, Murphy M, Austin L (1996) Leukemia inhibitory factor and interleukin-6 are produced by diseased and regenerating skeletal muscle. Muscle Nerve 19:1291–1301CrossRefPubMedGoogle Scholar
  19. 19.
    Bar-Yehuda S, Barer F, Volfsson L, Fishman P (2001) Resistance of muscle to tumor metastases: a role for A3 adenosine receptor agonists. Neoplasia 3:125–131CrossRefPubMedGoogle Scholar
  20. 20.
    Weiss L (1989) Biomechanical destruction of cancer cells in skeletal muscle: a rate-regulator for hematogenous metastasis. Clin Exp Metastasis 5:483–491CrossRefGoogle Scholar
  21. 21.
    Seely S (1980) Possible reasons for high resistance of muscle to cancer. Med Hypotheses 6:133–137CrossRefPubMedGoogle Scholar
  22. 22.
    Mulsow F (1943) Metastatic carcinoma of skeletal muscle. Arch Pathol 35:112–114Google Scholar
  23. 23.
    Batson OV (1940) The function of the vertebral veins and their role in the spread of metastases. Ann Surg 112:138–149CrossRefPubMedGoogle Scholar
  24. 24.
    Yiotakis J, Hantzakos A, Kostakopoulos A, Adamopoulos G (2001) Intramasseteric metastasis of renal cell carcinoma. J Laryngol Otol 115:65–67PubMedGoogle Scholar
  25. 25.
    LaBan MM, Chamberlain CC, Jaiyesimi I, Shetty AN, Wang AM (1998) Paravertebral muscle metastases as imaged by magnetic resonance venography: a brief report. Am J Phys Med Rehabil 77:553–556CrossRefPubMedGoogle Scholar
  26. 26.
    Yuh WT, Quets JP, Lee HJ, Simonson TM, Michalson LS, Nguyen PT, Sato Y, Mayr NA, Berbaum KS (1996) Anatomic distribution of metastases in the vertebral body and modes of hematogenous spread. Spine 21:2243–2250CrossRefPubMedGoogle Scholar
  27. 27.
    Vider M, Maruyama Y, Narvaez R (1977) Significance of the vertebral venous (Batson’s) plexus in metastatic spread in colorectal carcinoma. Cancer 40:67–71CrossRefPubMedGoogle Scholar
  28. 28.
    Harada M, Shimizu A, Nakamura Y, Nemoto R (1992) Role of the vertebral venous system in metastatic spread of cancer cells to the bone. Adv Exp Med Biol 324:83–92PubMedGoogle Scholar
  29. 29.
    Cumming J, Hacking N, Fairhurst J, Ackery D, Jenkins JD (1990) Distribution of bony metastases in prostatic carcinoma. Br J Urol 66:411–414CrossRefPubMedGoogle Scholar
  30. 30.
    Sener RN, Calli C, Kitis O, Yalman O (2001) Multiple, primary spinal-paraspinal hydatid cysts. Eur Radiol 11:2314–2316CrossRefPubMedGoogle Scholar
  31. 31.
    Yang WT, Yeo W, Metreweli C (1999) Imaging of iliopsoas metastasis. Clin Radiol 54:85–89CrossRefPubMedGoogle Scholar
  32. 32.
    Travis WD, Banks PM, Reiman HM (1987) Primary extranodal soft tissue lymphoma of the extremities. Am J Surg Pathol 11:359–366CrossRefPubMedGoogle Scholar
  33. 33.
    Lee JK, Glazer HS (1986) Psoas muscle disorders: MR imaging. Radiology 160:683–687PubMedGoogle Scholar
  34. 34.
    Suresh S, Saifuddin A, O’Donnell P (2008) Lymphoma presenting as a musculoskeletal soft tissue mass: MRI findings in 24 cases. Eur Radiol 18:1628–1634CrossRefGoogle Scholar
  35. 35.
    Blandino A, Gaeta M, Minutoli F, Pandolfo I (2000) CT and MR findings in neoplastic perineural spread along the vidian nerve. Eur Radiol 10:521–526CrossRefPubMedGoogle Scholar
  36. 36.
    Chong VF, Fan YF (2002) Hypoglossal nerve palsy in nasopharyngeal carcinoma. Eur Radiol 8:939–945CrossRefGoogle Scholar
  37. 37.
    Nagao E, Nishie A, Yoshimitsu K, Irie H, Shioyama Y, Naito S, Matsuura S, Honda H (2004) Gluteal muscular and sciatic nerve metastases in advanced urinary bladder carcinoma: case report. Abdom Imaging 29:619–622CrossRefPubMedGoogle Scholar
  38. 38.
    Crundwell N, O’Donnell P, Saifuddin A (2007) Non-neoplastic conditions presenting as soft-tissue tumours. Clin Radiol 62:18–27CrossRefPubMedGoogle Scholar
  39. 39.
    Prado MA, Miró RL, Leal IM, Vargas J, Dorrego EJ (2002) Intramuscular myxoma: differential diagnosis and review of the literature. Orthopedics 25:1297–1299PubMedGoogle Scholar
  40. 40.
    Martin S, Rapariz JM, Osés MJ, Martinez C (2007) A possible cause of multiple intramuscular masses: Mazabraud’s syndrome. Eur Radiol 18:417–421CrossRefGoogle Scholar
  41. 41.
    Völk M, Gmeinwieser J, Hanika H, Manke C, Strotzer M (1998) Ischiogluteal bursitis mimicking soft-tissue metastasis from a renal cell carcinoma. Eur Radiol 8:1140–1141CrossRefPubMedGoogle Scholar
  42. 42.
    Mills GM, Baethge BA (1993) Ischiogluteal bursitis in cancer patients: an infrequently recognized cause of pain. Am J Clin Oncol 16:229–231CrossRefPubMedGoogle Scholar
  43. 43.
    Devendra K, Tay SK (2003) Metastatic carcinoma of the cervix presenting as a psoas abscess in an HIV-negative woman. Singapore Med J 44:302–303PubMedGoogle Scholar
  44. 44.
    Masters JG, Cumming JA, Jennings P (1996) Psoas abscess secondary to metastases from transitional cell carcinoma of the bladder. Br J Urol 77:155–156PubMedGoogle Scholar
  45. 45.
    Hundt W, Braunschweig R, Reiser M (1999) Diffuse metastatic infiltration of a carcinoma into skeletal muscle. Eur Radiol 9:208–210CrossRefPubMedGoogle Scholar
  46. 46.
    Eustace S, Winalski CS, McGowen A, Lan H, Dorfman D (1996) Skeletal muscle lymphoma: observation at MR imaging. Skeletal Radiol 25:425–430CrossRefPubMedGoogle Scholar
  47. 47.
    Connor SE, Chavda SV, West R (2000) Recurrence of non-Hodgkin’s lymphoma isolated to the right masticator and left psoas muscles. Eur Radiol 10:841–843CrossRefPubMedGoogle Scholar
  48. 48.
    Lee VS, Martinez S, Coleman RE (1997) Primary muscle lymphoma: clinical and imaging findings. Radiology 203:237–244PubMedGoogle Scholar
  49. 49.
    Beggs I (1997) Primary muscle lymphoma. Clin Radiol 52:203–212CrossRefPubMedGoogle Scholar
  50. 50.
    Narváez JA, Narváez J, Clavaguera MT, Juanola X, Valls C, Fiter J (1998) Bone and skeletal muscle metastases from gastric adenocarcinoma: unusual radiographic, CT and scintigraphic features. Eur Radiol 8:1366–1369CrossRefPubMedGoogle Scholar
  51. 51.
    Geukens DM, Vande Berg BC, Malghem J, De Nayer P, Galant C, Lecouvet FE (2001) Ossifying muscle metastases from an esophageal adenocarcinoma mimicking myositis ossificans. AJR Am J Roentgenol 176:1165–1166PubMedGoogle Scholar
  52. 52.
    Stabler J (1995) Case report: ossifying metastases from carcinoma of the large bowel demonstrated by bone scintigraphy. Clin Radiol 50:730–731CrossRefPubMedGoogle Scholar
  53. 53.
    Rosenbaum LH, Nicholas JJ, Slasky BS, Obley DL, Ellis LD (1984) Malignant myositis ossificans: occult gastric carcinoma presenting as an acute rheumatic disorder. Ann Rheum Dis 43:95–97CrossRefPubMedGoogle Scholar
  54. 54.
    McCarthy EF, Sundaram M (2005) Heterotopic ossification: a review. Skeletal Radiol 34:609–619CrossRefPubMedGoogle Scholar
  55. 55.
    Baysal T, Baysal O, Sarac K, Elmali N, Kutlu R, Ersoy Y (1999) Cervical myositis ossificans traumatica: a rare location. Eur Radiol 9:662–664CrossRefPubMedGoogle Scholar
  56. 56.
    Hottat N, Fumière E, Delcour C (1999) Calcific tendinitis of the gluteus maximus tendon: CT findings. Eur Radiol 9:1104–1106CrossRefPubMedGoogle Scholar
  57. 57.
    Arsenovic NN, Sen S, Patel J, Terzic M, Reed M (2009) Angiomatosis: a case with metaplastic ossification. Am J Dermatopathol 31:367–369CrossRefPubMedGoogle Scholar
  58. 58.
    Boutry N, Hachulla E, Zanetti-Musielak C, Morel M, Demondion X, Cotten A (2007) Imaging features of musculoskeletal involvement in systemic sclerosis. Eur Radiol 17:1172–1180CrossRefPubMedGoogle Scholar
  59. 59.
    Dhillon M, Davies AM, Benham J, Evans N, Mangham DC, Grimer RJ (2004) Calcific myonecrosis: a report of ten new cases with an emphasis on MR imaging. Eur Radiol 14:1974–1979CrossRefPubMedGoogle Scholar
  60. 60.
    Baud O, Dubost JJ, Soubrier M, Boisgard S, Verelle P, Sauvezie B (1997) Recurrent posttraumatic hematoma leading to discovery of a muscle metastasis. Rev Rhum Engl Ed 64:433PubMedGoogle Scholar
  61. 61.
    Muttarak M, Peh WCC (2000) CT of unusual iliopsoas compartment lesions. Radiographics 20:S53–S66PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Alexey Surov
    • 1
    Email author
  • Michael Hainz
    • 2
  • Hans-Jürgen Holzhausen
    • 2
  • Dirk Arnold
    • 3
  • Michaela Katzer
    • 4
  • Joerg Schmidt
    • 5
  • Rolf Peter Spielmann
    • 1
  • Curd Behrmann
    • 1
  1. 1.Department of RadiologyMartin-Luther-University Halle-WittenbergHalleGermany
  2. 2.Department of PathologyMartin-Luther-University Halle-WittenbergHalleGermany
  3. 3.Department of Haematology/OncologyMartin-Luther-University Halle-WittenbergHalleGermany
  4. 4.Department of UrologyMartin-Luther-University Halle-WittenbergHalleGermany
  5. 5.Department of Medical Statistics and ControllingMartin-Luther-University Halle-WittenbergHalleGermany

Personalised recommendations