Lessons to be learned: a case study approach: Metastatic bronchogenic carcinoma presenting as a gluteal abscess

Abstract

It is well known that bronchogenic carcinoma frequently metastasises to the bony skeleton, but it is most unusual for it to present in the form of a musculoskeletal abscess. Presented here is the case report of a patient with what appeared initially to be a right sided gluteal abscess and which turned out to be the metastasis from a bronchogenic carcinoma. The Magnetic Resonance Image (MRI) scan carried out proved to be very helpful in arriving at a probable clinical diagnosis; however, it was histopathological studies of the abscess wall itself that ultimately gave the definitive diagnosis. We believe that this may represent one of the first documented cases in which on MRI scan has been used to confirm the presence of a gluteal abscess.

Right Gluteal Abscess: An Unusual Presentation of Perforated Caecal Adenocarcinoma

“…Retroperitoneal abscess in the western population usually occurs following perforation of adjacent bowel [11] secondary to inflammatory bowel disease, diverticular disease, neoplastic disease, perforated appendicitis and trauma [12]. Rarely can retroperitoneal abscess occur due to pyonephrosis [13], empyema or tuberculosis of the spine [13], post radiation and metastasis from bronchogenic carcinoma [14]. The abscess may remain in the retroperitoneal space or may tract into the gluteal region, thigh, groin or anterior abdominal wall.…”

“…Gluteal abscess can occur due to infection of a degenerated hematoma or seroma following trauma or surgery like hip operations, spread of intra pelvic sepsis to the gluteal region [18] and rarely spread from colonic carcinoma [11] and metastatic bronchogenic carcinoma [14]. Extra abdominal spread of intraabdominal sepsis occurs through two possible route (a) direct soft tissue extension or (b) through the natural abdominal wall defects mainly the femoral canal, obturator foramen, sacrosciatic foramen and along the psoas muscle behind the ileofemoral vessels into the thigh [17].…”

Non-small-cell lung cancer: unusual presentation in the gluteal muscle

“…The only form of lung metastasis to the gluteal region has been reported as an abscess. 4 Intramuscular metastasis of malignant tumors is considered to be rare. The frequency of intramuscular metastasis, based on autopsy fi ndings, was reported by Willis 5 to be 0.8% in patients with cancer and by Berge and Lundberg 6 to be 1% in patients with lung cancer.…”

Endosonographische Diagnostik pelviner Metastasen von Bronchialkarzinomen

“…In einer Publikation aus dem Jahr 1975 wird die Häufigkeit der Metastasierung des Bronchialkarzinoms in das Rektum in 16 394 Sektionen mit 747 Fällen eines Bronchialkarzinoms in 2,2% der Fälle beschrieben [1]. Allerdings liegen Einzelfallberichte über das Auftreten von Metastasen von Bronchialkarzinomen als Glutealabszess [10,12,17,19], Metastase der Vulva [14], Ovarialmetastase [2], Metastase des Anus [8,9] [7,11,16].…”