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Age / Sex : /
Age / Sex: 49/M
Chief complaint : Rt. Forearm Mass
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
* Send Application Answers to Ja-Young Choi, MD (drchoi01@radiol.snu.ac.kr)
Courtesy : Seoung-Oh Yang, MD. Department of Radiology, Eulji University Hospital
Diagnosis: metastatic adenocarcinoma
Discussion
Findings:
Right forearm mass is seen in the brachialis muscle region.
On T1WI: isointense SI with peripheral Gd-enhancement, on T2WI; heterogenous high SI mass. Forearm biopsy revealed metastatic adenocarcinoma. Therefore, PET/CT was performed to assess the primary focus. In addition to the right forearm mass, there are many FDG-avid lesions in the RUL, LAP, liver, both adrenal glands and multiple bones(rib, humerus, femur etc) on PET/CT.
Differential Diagnosis:
Soft tissue tumor in Rt. brachialis muscle,
R/O MFH , Skeletal muscle metastasis
Diagnosis: Lung cancer with multiple muscular, skeletal, hepatic, lymphatic and both adrenal metastases
Discussion:
Skeletal muscle metastasis is often presented as a painful mass in patients with known primary carcinoma. For diagnosis, needle biopsy is mandatory. However, PET/CT can be considered before biopsy. A painful mass with an extensive peritumoral enhancement should be highly suspected to represent carcinoma metastasis to skeletal muscles.
References:
1. Tuoheti Y, Okada K, Osanai T, et al: Skeletal muscle metastases of carcinoma: a clinicopathological study of 12 cases. Jpn J Clinic Oncol 2004; 34:210-214.
2. Herring CL Jr, Harrelson JM, Scully SP: Metastatic carcinoma to skeletal muscle. A report of 15 patients. Clin Orthop Relat Res 1998; 355:272-281.
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