Title: A RARE CASE OF INTERNAL ABDOMINAL OBLIQUE METASTASIS OF LUNG ADENOCARCINOMA
Abstract: SESSION TITLE: Mediastinum Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Lung cancer is the leading cause of cancer-related death in the United States, and it is the most frequently diagnosed type of cancer worldwide. Metastasis to soft tissues is uncommon, with an incidence of 0.75–9%. Consequently, metastasis to the abdominal muscles has been rarely reported in the medical literature. CASE PRESENTATION: Our patient is a 60-year-old woman with a past medical history of nicotine use disorder, and chronic obstructive lung disease who presented to the emergency department (ED) for abdominal pain for a one-week duration. She had a work-up done six months prior to the current presentation due to shortness of breath and hemoptysis. A computerized tomography (CT) scan of the chest showed a right lung 3x2 cm nodule. A positron emission tomography scan exhibited active disease in the liver and lymph nodes. Further pathological workup showed that the cells were immunoreactive for CK7 and TTF-1 and negative for CK5/6 and PD-L1, confirming the diagnosis of adenocarcinoma of the right lung (T3N2pM1c) with metastases to the liver and lymph nodes. It was treated with six cycles of Carboplatin and Pemetrexed. Upon the present admission, the patient reported a severe, non-radiating, generalized dull abdominal pain. Physical exam showed stable vital signs, generalized abdominal tenderness, and ecchymosis on the right abdominal wall with no palpable mass. A CT scan of the abdomen and pelvis revealed a new dense mass in the internal oblique muscle. Biopsy of the mass confirmed the presence of adenocarcinoma, with the lung being the primary sources of malignancy. The patient was discharged with radiation and chemotherapy orders as an outpatient and close follow-up. DISCUSSION: Lung cancer usually metastasizes through lymph and blood to the liver, lungs, bone, and brain. However, it can rarely metastasize to soft tissues. The most common site of metastasis to skeletal muscles is the thigh. Prior et al. described the first case of muscle metastasis from the lung in 1854. Willis et al. performed 500 autopsies on patients with cancer and discovered only four cases of skeletal muscle metastasis. Pain is the most common symptom, and in the majority of cases of soft tissue metastases, a palpable mass is present. Diagnostic imaging studies and biopsies are essential to confirm the diagnosis. In patients with oligometastatic disease, radical surgery is considered. Chemotherapy and palliative radiation treatment are options for patients with extensive metastases and a poor overall functional status. CONCLUSIONS: This case highlights a rare soft tissue metastasis of lung cancer. Soft tissue metastasis should be considered in the differential diagnosis of cancer patients who present with skin changes, e.g., unexplained ecchymosis and new lumps, to ensure an optimal management approach. Reference #1: Siddiqui F, Vaqar S, Siddiqui AH. Lung Cancer. [Updated 2021 Dec 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482357/ Reference #2: Prior C. [Metastatic tumors in striated muscle; review and case report]. Riv Anat Patol Oncol 1953;6:543–560 Reference #3: Willis R A.A review of five hundred consecutive cancer autopsies Med J Aust 1941210258–265.cited 2019 Jul 12 [Internet] from https://onlinelibrary.wiley.com/doi/abs/10.5694/j.1326-5377.1941.tb53986.x DISCLOSURES: No relevant relationships by Abdul Rahman Al Armashi No relevant relationships by Anas Al Zubaidi No relevant relationships by Akram Alkrekshi No relevant relationships by Dina Elantably No relevant relationships by Faris Hammad No relevant relationships by Kanchi Patell No relevant relationships by Keyvan Ravakhah No relevant relationships by Francisco Somoza-Cano
Publication Year: 2022
Publication Date: 2022-10-01
Language: en
Type: article
Indexed In: ['crossref']
Access and Citation
Cited By Count: 1
AI Researcher Chatbot
Get quick answers to your questions about the article from our AI researcher chatbot