三角筋転移で発見された肺腺癌の 1 例

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Lung cancer metastasis to skeletal muscles is rare. We treated a patient with pulmonary adenocarcinoma who presented himself with metastasis to the deltoid muscle. Case:A 68-year-old man who complained of right shoulder pain visited a local physician. He was diagnosed with periarthritis scapulohumeralis and administered conservative treatment (steroid injection and physical therapy). Progressive severe pain continued for 3 months, leading the patient to consult with us. His shoulder appeared swollen and red and was warm. He had a history of diabetes, but not of trauma. Physical examinations confirmed that the active range of motion was restricted to 80° both in flexion and abduction. Blood examination findings suggested purulent arthritis of the shoulder and revealed severe anemia. Enhanced MRIs showed 8 × 6 cm heterogeneous mass lesion in the deltoid muscle. Needle biopsy was performed, and histological examination revealed poorly differentiated metastatic adenocarcinoma. Chest X-rays and a CT scan showed tumor in the right lung lobe. The patient underwent chemotherapy but died after 9 days because of pneumonia. Skeletal muscles are rare metastatic sites, even though muscles account for 40% of the total body weight. In this case, cancer cells might adhere to the muscle easily in blood borne metastasis because of hematoma after injection therapy. One of the reasons why diagnosis was delayed was that conservative treatment was administered without suspecting the true diagnosis because the early symptoms of periarthritis scapulohumeralis resemble those of deltoid muscle metastasis. Metastatic tumors should be suspected when symptoms such as fever, local heat, and swelling occur. Enhanced MRI and needle biopsy were very useful for the diagnosis.

三角筋転移で発見された肺腺癌の 1 例

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