AB034. Muscular metastasis from non-small cell lung cancer: a case report

Abstract: Non-small cell lung cancer (NSCLC) is the most commonly observed group and represents 80–85% of all lung cancers. Males are more affected than females, an effect which is directly related to smoking. Metastases commonly involve the contralateral lung, bone, brain, adrenal and liver. Muscle metastases from NSCLC are quite rare and commonly presented as painful masses. We present the case of a 66-year-old man who was admitted to our Department for evaluation of hemoptysis and general weakness. Computed tomography (CT) of the chest revealed a complete atelectasis of the right upper lobe by a mass growing from the right hilum along with lymphadenopathy of upper mediastinum. The patient underwent a bronchoscopy which confirmed the diagnosis of NSCLC. Brain CT, abdomen CT and bone scan did not initially revealed metastatic disease. After completion of six cycles of platinum based first-line chemotherapy, chest CT revealed disease progression and the patient was started on second-line chemotherapy. The rest of the restaging was normal. After completion of six cycles of second-line chemotherapy, the patient complained of pain in the right hip area. Physical exam revealed important restriction of mobility and swelling of the area. A MRI scan of hips showed three abnormal signal foci in the right vastus lateralis, the right rectus femoris and the left adductor brevis muscle, diameter 23, 14 and 21 mm respectively, surrounded by intense edema and hyperemia. The patient started on gemcitabine as third-line chemotherapy and he was referred for palliative radiotherapy. He suddenly died, though, because of hemoptysis in few days. This case supports that muscle metastases, even rare, should be included in the differential diagnosis of oncological patients presenting with an intramuscular mass.

Keywords: Non-small cell lung cancer (NSCLC); chemotherapy; muscular metastasis