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Figure 2: Fine-needle aspiration cytology from skeletal muscle mass
showing nests of pleomorphic squamous cells (bold arrowhead)
Figure 1: Contrast enhanced computed tomography-thorax showing skeletal
[7]
muscle metastasis in the paraspinal and intercostal muscles invading the and enhancement on gadolinium. Our patient declined an
vertebra (red arrow) and lung metastasis (white arrow) MRI scan. Differentiation between a primary sarcoma and
metastatic carcinoma is difficult without a biopsy/FNAC. The
[8]
fornices were flushed, and vagina was small and conical. FNAC was done, which showed metastasis from squamous
The patient remained locoregionally controlled for 1 year, cell carcinoma in the muscles. Primary squamous cell
after which she presented with complaints of swelling in carcinoma in muscle is not recognized, and thus we have
the left side of the back along with pain. On examination, concluded that this is a metastasis from the past diagnosis
a large tender swelling was seen on left paraspinal of cervical cancer.
region, size around 8 cm × 4 cm, hard and fixed. Vaginal
examination performed at the time showed growth over The outcome of the patients with skeletal metastasis is
cervix extending to involve upper 2/3 of the vagina, and usually poor mostly due to diffuse metastasis and a lack
both the parametrium were involved. Contrast-enhanced of consensus on treatment options. When exercised,
computed tomography (CT)-thorax revealed a huge mass treatment options include radiotherapy, chemotherapy,
in the left paraspinal muscles, involving the vertebrae along and surgery according to the site number and extension
with multiple lung secondaries [Figure 1]. Fine-needle of the lesion. In the case of a solitary skeletal muscle
aspiration cytology (FNAC) from back mass revealed metastasis, metastasectomy has been performed, followed
metastatic squamous cell carcinoma [Figure 2]. The patient by radiotherapy. The general consideration of skeletal
[4]
was advised for palliative local radiotherapy to vertebra muscle metastasis usually requires chemotherapy, in
followed by chemotherapy, but patient declined treatment particular, the platinum-taxane combination is often chosen
and went home and succumbed to the disease. because of high response rate documented with this regimen
as compared to cisplatin alone. Palliative radiotherapy or
[10]
DISCUSSION combined radiotherapy and chemotherapy are effective in
controlling pain and size of the metastatic lesion.
[9]
The incidence of metastasis to skeletal muscles is < 1% of
all hematogenous metastasis despite the fact that the muscles A reason for the prevalence (I have changed incidence to
represent 50% of total body mass in a person. Cancer cell prevalence) of skeletal muscle metastasis in cervix cancer
[2]
survival is found more in denervated muscle, which is unable being low may be due to difficulty in differentiating
to contract rather than those stimulated one. [3] malignant from benign lesions. Thus, in a patient with the
previous history of cancer presenting with soft tissue mass,
Skeletal muscle involvement from cervical cancer is very skeletal muscle metastasis should be considered and should
rare. Since 2008, only 10 cases with muscle metastasis be confirmed with imaging modalities and FNAC/biopsy.
[4]
from cervical cancer have been reported in literature. On confirmation palliative chemotherapy with or without
Deleted the third mention of the fact that the most common local radiotherapy for pain should be given.
site of muscle metastasis is psoas. [5,6] Various imaging
modalities have been used to identify metastasis to muscle, Muscular pain or weakness or just a palpable mass in a
but none of them are specific in differentiating carcinomas, patient with a history of cervical cancer should always raise
sarcomas and other muscle disorders. CT scans show the suspicion of the metastatic muscular disease even after
muscle metastasis as muscle enlargement but cannot specify many years of locally controlled disease.
this as malignant. Magnetic resonance imaging (MRI) in
metastatic lesions show low to intermediate intensity on T1- Financial support and sponsorship
weighted images, high intensity on T2-weighted images, Nil.

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Journal of Cancer Metastasis and Treatment ¦ Volume 2¦ Issue 2 ¦ February 29, 2016 ¦