|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 3 | Page : 369-370
An unusual presentation of pancreatic cancer: Muscular metastasis
R Belbarka1, Z Fadoukheir2, C Delafouchardiere3, F Desseigne3, H Errihani3
1 Department of Medical Oncology, Centre Oncology-Hematology, Cadi Ayad University, Marrakech, Morocco
2 Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
3 Department of Medical Oncology, Centre Leon Berard, Lyon, France
|Date of Web Publication||10-Dec-2014|
Dr. R Belbarka
Department of Medical Oncology, Centre Oncology-Hematology, Cadi Ayad University, Marrakech
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Belbarka R, Fadoukheir Z, Delafouchardiere C, Desseigne F, Errihani H. An unusual presentation of pancreatic cancer: Muscular metastasis. Indian J Cancer 2014;51:369-70
|How to cite this URL:|
Belbarka R, Fadoukheir Z, Delafouchardiere C, Desseigne F, Errihani H. An unusual presentation of pancreatic cancer: Muscular metastasis. Indian J Cancer [serial online] 2014 [cited 2019 Jun 26];51:369-70. Available from: http://www.indianjcancer.com/text.asp?2014/51/3/369/146714
Muscular metastasis of pancreatic cancer is rare. In fact, the skeletal muscle is a very unusual site of metastasis from any malignancy. In autopsy series, the frequency of microscopic intramuscular metastases is only 16%.  Three cases have been reported in the literature. We described here an interesting case of muscular pancreatic metastasis. ,,
A 58-year-old Caucasian woman was admitted to the Medical Oncology department in Leon Berard Center with epigastralgia, dorsal pain, and continuous weight loss for the past 2 months.
Upon initial staging, the Eastern Cooperative Oncology Group (ECOG) performance status was equal to 2. Physical examination showed no abnormalities.
Abdominal computed tomography (CT) scan showed a huge lesion of the caudal pancreas measuring 10 cm infiltrating the left kidney [Figure 1]. This mass was associated with multiple nodules of the liver, peritoneal effusion, portal hypertension, and multiple skeletal lesions of paravertebrals and gluteal muscles [Figure 2] and [Figure 3]. CA 19-9 was elevated (300 UI/l).
|Figure 1: Abdominal CT scan showing a caudal pancreatic mass measuring 10/9/7 cm|
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|Figure 2: Abdominal CT scan showing metastatic infiltration of the right lobe and paravertebral muscles|
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|Figure 3: CT scan showing multiple metastatic lesions in the obturator and gluteal muscles|
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A scan-guided biopsy of the muscular mass was performed. Histological and immunohistochemistry studies showed an undifferentiated tumoral process. Most of the tumor cells were positive for anti-keratin cocktail, anti-keratin-7, and anti-endomysial (anti-EMA) antibodies.
Neuroendocrine markers, S-100 protein, anti-hepatocyte antibody, and anti-cytokeratin-20 were negative.
To eliminate a vascular or sarcomatous tumor, other markers were studied (anti-CD31, anti-CD34, anti-factor-VIII, anti-CK5/6, calretinin, anti-desmin).
According to the clinical, biological, radiological, and histological elements, we concluded a muscular metastasis from an undifferentiated pancreatic carcinoma.
The patient was treated with an association of chemotherapy with 5-fluorouracil, irinotecan, and oxaliplatin (folfirinox protocol) in a phase II-III clinical study (ACCORD 11 trial). She died of acute hematemesis from esophageal varix rupture after two cycles.
Skeletal muscle is a rare site for metastases, with only 242 cases being reported previously. Primary cancers of the lung, hematological malignancies, gastrointestinal tract, and genitourinary tract were the most frequently involved.
Only three cases of muscular metastasis from pancreatic cancer have been reported in the literature. ,,
Various theories have been proposed to explain the resistance of the skeletal muscle to both primary and metastatic cancer, and the relative rarity of skeletal muscle metastases, given the fact that the skeletal muscle accounts for a large percentage of total body weight: Variability of blood flow, intermittent muscular contraction, lactic acid metabolism and pH, presence of diffusible proteases, and other inhibitors that may block the enzyme-dependent processes of invasion or tumor growth.  Organs with a high incidence of metastases, such as lungs, liver, and bones of the axial skeleton, have extensive capillary vascularization and a relatively constant blood flow. By contrast, although skeletal muscles have a rich vasculature, the blood flow is extremely variable and under the influence of b-adrenergic receptors. Irrespective of high blood flow, skeletal muscle tissue may be a poor recipient for tumors, which may be related to lactic acid metabolism.  These different factors that inhibit the growth of metastases in the skeletal muscle did not prevent the growth of metastases in our case.
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[Figure 1], [Figure 2], [Figure 3]