Gastrocnemius acrometastasis from muscle-invasive urothelial bladder carcinoma: A case report

Abstract

Urinary bladder carcinoma is a common malignancy worldwide. The metastatic disease to distant organs including lung, liver, and bone is well established. However, metastasis to below-knee-level; also known as acrometastasis is a rare occurrence and occurs approximately 0.1% of all bone metastases. It is standard of care to obtain a contrast enhanced computed tomography scan of the chest, abdomen, and pelvis for pretreatment planning, primary staging, and post treatment disease surveillance. This makes the occurrence of acrometastasis harder to detect and may only manifest clinically in advance disease. We report a case of 55 years old gentleman treated as muscle-invasive bladder urothelial carcinoma, presented with chronic left knee pain, and imaging demonstrating tumor in the left knee region. Histopathologic study shows features of metastatic disease from urinary bladder carcinoma to the left gastrocnemius muscle. The attending physician should raise the suspicion of metastatic disease if the patient with known malignancy presented with new soft tissue lesion elsewhere in the body.

Cardiac and Intramuscular Metastases Following Nephroureterectomy for Metachronous Urothelial Carcinoma

“…In our literature review, we found that intramuscular metastases from urothelial cancer have been reported most commonly in the iliopsoas [ 23 ], with other sites also reported, including the deltoid [ 24 ], rectus abdominis [ 25 ], adductors [ 25 ], sartorius [ 26 ], and gastrocnemius [ 27 ]. Intramuscular metastasis can present as localized pain but can also present as secondary to a compressive effect on surrounding structures [ 28 ].…”

“…Chemotherapy and radiotherapy are utilized in patients who are contraindicated for surgery or as adjunct therapy with palliative debulking surgery to prevent local recurrence [ 39 ]. For intramuscular metastases, chemotherapy and radiotherapy can be administered for pain relief or reduction in mass effect from intramuscular metastases [ 26 , 27 ]. As patients often have widespread metastasis at presentation, surgery is only reserved for those with isolated soft-tissue metastases after a long disease-free interval.…”

Upper Tract Urothelial Carcinoma Complicated by Skeletal Muscle Metastases

“…Typically, urothelial carcinoma progresses by local invasion or lymphatic spread with hematogenous spread occurring less often [4]. Some of the most common areas of metastasis include lymph node, lung, and bone [7]. Skeletal muscle metastasis of urothelial carcinoma is extremely rare with less than 20 cases previously reported.…”

Pedal acrometastasis secondary to urothelial carcinoma masquerading as Charcot arthropathy in a patient with diabetes

“…Other cases have been reported in the literature of acrometastasis failing to be appropriately recognised for several reasons 14 15. CT thorax, abdomen and pelvis is often used as the standard workup to screen for distant metastasis; a modality that clearly does not provide imaging of the extremities.…”