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LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 3  |  Page : 450-451
Carcinoma cervix with atypical presentation of metastatic lesion as a cyst in the right deltoid muscle


1 Department of Radiotherapy, AH Regional Cancer Centre, Cuttack, Orissa, India
2 Department of Oncopathology, AH Regional Cancer Centre, Cuttack, Orissa, India

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How to cite this article:
Padhi S, Banerjee S, Das S, Rout N. Carcinoma cervix with atypical presentation of metastatic lesion as a cyst in the right deltoid muscle. Indian J Pathol Microbiol 2008;51:450-1

How to cite this URL:
Padhi S, Banerjee S, Das S, Rout N. Carcinoma cervix with atypical presentation of metastatic lesion as a cyst in the right deltoid muscle. Indian J Pathol Microbiol [serial online] 2008 [cited 2021 Oct 19];51:450-1. Available from: https://www.ijpmonline.org/text.asp?2008/51/3/450/42527


Sir,

The incidence in skeletal muscle metastasis in carcinoma cervix is reported to be less than 1%. [1] Till 2006, nine cases of skeletal muscle metastasis have been reported. The most frequent site being the psoas muscle; however, metastasis to massetor, intercostal, biceps and deltoid muscle have also been reported.[1] But till now no case has been reported where the metastasis occurred in the form of a cyst in the deltoid muscle.

A 37-year-old female was diagnosed as a case of poorly differentiated squamous cell carcinoma cervix (Stage-II B) in the month of September 2005. She was treated with external beam radiotherapy and concurrent weekly chemotherapy. In subsequent days, she received three fractions of High Dose Rate brachytherapy. After the completion of treatment, her  Pap smear More Details showed no evidence of disease. But after 12 months of the completion of treatment, she presented with a swelling in the right deltoid region of size 4 cm 4 cm. There was no pain or tenderness associated with the swelling. The previous disease of carcinoma cervix was clinically controlled and the X-ray of the arm showed no bony abnormality. The fine needle aspiration cytology (FNAC) showed an amber-colored fluid that was negative for malignant cells, which was diagnosed cytologically as an inflammatory lesion. The patient was treated with a course of antibiotics to which she did not respond. Ultrasonography of the deltoid mass showed a well-defined, thick-walled cyst of size (8cm 4.5cm) adjacent to the bony surface. The lesion lying within the muscle plane showed internal debris, but there was no trace of calcification or septa. Ultrasonography-guided FNAC of the swelling was done.

Cytologically, the smears were hypocellular. There were few large polyhedral cells with pale eosinophalic cytoplasm and pleomorphic hyperchromatic nuclei. Some of the cells showed dyskeratosis, scattered inflamatory cells like lymphocytes, histiocytes and polymorphs. The mass including the cyst was excised and was subjected to histopathology. A collapsed cystic mass measuring 6 cm 2 cm 1 cm was received. The cyst wall was irregularly thickened with a smooth inner surface. Two sections were given from the thicker part of the cyst wall. The microsection showed poorly differentiated squamous carcinoma cells in sheets infiltrating the fibromuscular tissue. The cells had moderate-to-scanty cytoplasm with round, mild pleomorphic and hyperchromic nuclei. The diagnosis of poorly differentiated squamous cell carcinoma infiltrating the muscle was done. The observation of the histopathology picture showed similarity with the primary disease, i.e., poorly differentiated squamous cell carcinoma of the uterine cervix [Figure 1]. The surgical wound healed subsequently and the patient received 30Gy of external beam radiotherapy to the arm. The patient responded well and is now under follow-up.

A case of carcinoma cervix with metastasis to the deltoid muscle was reported where she presented with a painful swelling over the shoulder during the course of treatment of the primary disease. [2] However, no evidence of metastasis as a cyst in the intramuscular plane has been reported earlier. Hence, this is most probably the first case to be reported. Any painful soft tissue mass occurring in patients with a known history of carcinoma is highly suspicious for skeletal muscle metastases in comparison to soft tissue sarcoma, which is relatively less painful. [3] However, our patient presented with a painless and cystic swelling, giving the impression of benign tumor. Treatment of these patients depends upon the clinical setting as well as the condition of the patient which may include radiotherapy, chemotherapy and surgical excision. In our case, we have done adequate excision and subjected her to adjuvant radiotherapy. The patient is doing well at the time of preparation of this report.

Hence, every swelling in the case of a known patient of malignancy, however benign it may appear, should be investigated properly by imaging followed by an FNAC and/or histopathological examination for proper management.

 
   References Top

1.Ferrandina G, Salutari V, Testa A, Zannoni GF, Petrillo M, Scambia G. Recurrence in skeletal muscle from squamous cell carcinoma of the uterine cervix: A case report and review of the literature. BMC Cancer 2006;6:169.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Pathy S, Jayalakshmi S, Chander S, Thulkar S, Sharma MC. Carcinoma cervix with metastases to deltoid muscle. Clin Oncol 2002;14:447-8.  Back to cited text no. 2    
3.Tuoheti Y, Okada K, Osanai T, Nishida J, Ehara S, Hashimoto M, et al . Skeletal muscle metastases of carcinoma: A clinicopathological study of 12 cases. Jpn J Clin Oncol 2004;34:210-4.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Sanjukta Padhi
Department of Radiotherapy, A.H Regional Cancer Centre, Cuttack - 753 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.42527

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