Just another abdominal pain? Psoas abscess-like metastasis in large cell lung cancer with adrenal insufficiency

Multidisciplinary treatment of skeletal muscle metastasis from lung cancer: A case of triceps muscle metastasis of lung squamous cell cancer

A 62-year-old Japanese man presented a hard and painful intramuscular mass in the right upper arm during the chemotherapy for lung squamous cell carcinoma. Initially, this mass containing fluid accumulation was treated by radiotherapy and antibiotics as a muscle metastasis suspected to be complicated with local infection. However, because the swelling and pain of his right arm did not improve, he underwent a surgical debridement of the mass. These local treatments succeeded in relieving the patient's symptoms for a while. However, after temporary remission, the recurrence tumor developed the paralysis of right radial nerve and ulnar nerve in his upper arm. Despite further combined therapy including drainage, additional radiotherapy, and chemotherapy, paralysis made his performance status deteriorated. He was eventually discontinued aggressive treatment due to worsened general condition.

We herein report a case of lung cancer followed unusual course due to muscle metastasis in the triceps muscle. Because the paralysis caused by muscle metastasis can be the factor to deteriorate the performance status of patient, the combined therapy including antibiotics, debridement, radiotherapy and chemotherapy as early as possible should be considered to avoid its risk.

Retroperitoneal metastatic poorly differentiated carcinoma with β-human chorionic gonadotropin secretion presenting as a psoas abscess: A case report and review of the literature

RATIONALE

Psoas abscesses generally arise from a contiguous intra-abdominal or pelvic infectious process or hematogenous spreading of bacteria. The serum β-human chorionic gonadotropin has been used to detect normal or ectopic pregnancy. It also can be utilized in following up carcinomas.

PATIENT CONCERNS

Here, we reported a case of a 47-year-old woman who presented with a left psoas mass presumptively diagnosed as an abscess secondary to lumbar tuberculosis In addition, the patient had abnormal increase of β-human chorionic gonadotropin. The computed tomography (CT) scan and magnetic resonance imaging (MRI) showed that the 5th lumbar vertebral infection or tuberculosis with left psoas abscess. CT-guided percutaneous biopsy, surgical exploration and biopsy, and F-FDG (fluorodeoxyglucose) positron emission tomography-CT (PET-CT) were used to make a definite diagnosis. The sigmoidoscopy and biopsy were used to further diagnose.

DIAGNOSES

The biopsy of left psoas demonstrated metastatic or infiltrating poorly differentiated carcinoma with secretion of β-human chorionic gonadotropin. The subsequent pathological examination of neoplasm showed the same pathologic morphology.

INTERVENTIONS

Appropriate treatment of infected retroperitoneal mass, systematic chemotherapy and cancer biotherapy for metastatic poorly differentiated carcinoma were taken.

OUTCOMES

Interventions provided little help until the patient died of secondary infection and multiple organ failure.

LESSONS

This case represents an extremely unusual clinical presentation of metastatic poorly differentiated carcinoma with secretion of β-human chorionic gonadotropin presenting as a psoas abscess. Physicians also need to sharpen their awareness of the potential malignant carcinomas mimicking psoas abscess.

Adrenal Insufficiency Associated with Small Cell Lung Cancer: A Case Report and Literature Review

A 78-year-old Japanese man with fatigue, appetite loss, skin hyperpigmentation, hypotension and hypoglycemia, visited our hospital to evaluate an abnormal chest X-ray and adrenal gland swelling in echography in February 2015. Chest computed tomography showed a mass lesion in the right lower lobe and bilateral adrenal swellings, and small cell lung cancer (SCLC) with bilateral adrenal metastasis was diagnosed after bronchoscopy. According to low levels of serum cortisol, elevated adrenocorticotropic hormone (ACTH) and rapid ACTH test, the diagnosis of adrenal insufficiency associated with SCLC was made. Treatment with hydrocortisone (20 mg/day) was started in addition to systemic chemotherapy with carboplatin and etoposide. The patient's symptoms were slightly improved, however, systemic chemotherapy was discontinued according to the patient's request after 1 course of chemotherapy. Thereafter, he received only supportive care, and his general condition gradually worsened and he ultimately died in August 2015. Adrenal insufficiency associated with SCLC, which is caused by tissue destruction more than 90% of the adrenal glands, is rare although adrenal metastasis is not rare in patients with lung cancer. The findings such as general fatigue, appetite loss, hypotension, and hyponatremia are often got follow up as findings of advanced cancer, but appropriate therapy for adrenal insufficiency, supplement of the adrenal corticosteroid hormone, may lead to a significant improvement in the symptoms and quality of life in clinical practice of lung cancer. Therefore, physicians must consider potential adrenal insufficiency in lung cancer patients with bilateral adrenal metastasis.