Journal of Surgical Oncology 30:103-105 (1985

)

Intramyofiber Metastasis in Skeletal Muscle
DEBA P. SARMA, MD, THOMAS G. WEILBAECHER, MD, AND GORDON L. LOVE, MD

From the Department of Pathology, Veterans Administration Medical Center and Louisiana State University Medical School, New Orleans

Malignant epithelial cells were noted within the sarcolemmal sheath of skeletal muscle fibers in a case of recurrent laryngeal carcinoma. Literature is reviewed to evaluate the diagnostic and prognostic significance of this rare intramyofiber skeletal metastasis by cancer cells.
KEY WORDS: skeletal

muscle metastasis, intramyofiber skeletal muscle metastasis, sarcolemmal invasion by tumor cells, metastatic skeletal muscle tumor

INTRODUCTION

Skeletal muscle may be invaded by malignant tumors usually by direct extension. Rarely does a patient clinically present with a metastatic tumor in the skeletal muscle [Sarma et al, 1981]. Tumor cells usually invade the interstitial tissues and the lymphatics between the muscle fibers. A very rare form of invasion of the skeletal muscle is a direct invasion of the individual muscle fibers and extension within the sarcolemmal sheaths. The purpose of this paper is to report a case where we noted an intramyofiber skeletal muscle metastasis and to DISCUSSION review the literature to clarify the mechanism and signifTable I lists the reports of various cancers showing icance of this type of muscle metastasis. intramyofiber metastasis. Carcinomas have shown this peculiar form of muscle invasion more commonly than CASE REPORT the sarcomas, lymphomas, and leukemias. The breast A 60-year-old man was admitted to the hospital with a carcinomas appear to be the most commonly reported complaint of pain in the mid-neck and difficulty in swal- cancers to show intramyofiber invasion. Intramyofiber lowing. The patient had had squamous cell carcinoma of invasion by malignant cells appears to be part of a local the larynx 12 years previously, which was treated by invasion, rather than part of a distant hematogenous or laryngectomy, right radical neck dissection, and irradia- lymphatic spread. The exact mechanism through which tion. There were multiple occurrences of esophageal the malignant cells enter the myofibers has not been strictures that were treated by dilatation. elucidated from the human cases. However, Carr and Esophagoscopy disclosed a fungating lesion in the associates [1966], in an elaborate experimental study hypopharynx, a biopsy of which revealed a recurrent using electron microscopy, have shown that Rd/3 tumor poorly differentiated squamous cell carcinoma. cells in rats directly invade the muscle syncytia, often The malignant epithelial cells had invaded the skeletal accompanied by macrophages and polymorphs. muscle mostly in the form of islands of tumor between The diagnositc and prognostic significance of intramythe muscle bundles. There were areas of degeneration ofiber muscle invasion by carcinomas is not clear, partly and destruction of muscle bundles. In one area, nests of because of a lack of large series of cases. Only in Ewtumor cells were noted within the muscle fibers sur- ing's sarcoma of bone with intramyofiber invasion has rounded by a rim of sarcoplasm (Fig. 1). The cross Accepted for publication August 6, 1984. striations were visible in the sarcoplasm. There was no Address reprint requests to D. Sarma, MD, 1601 Perdido Street, New significant increase in the numbers of muscle nuclei in Orleans, LA 70146.
© 1985 Alan R. Liss, Inc.

the invaded muscle. The interstitium in this area was free of tumor cells or inflammatory cells. A work-up including chest roentgenograms and scans of various organs and bone did not yield any evidence of metastatic disease. The patient underwent a total hypopharyngectomy and proximal cervical esophagectomy with placement of feeding jejunostomy tube and gastrostomy. The postoperative course was uneventful. Two months later, the patient remained free of recurrent or metastatic tumor.

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Fig. 1. Intramyofiber skeletal muscle metastasis by poorly differentiated squamous cell carcinoma of the larynx (H & E, X 280).

TABLE I. Intramyofiber Skeletal Muscle Metastases From Various Cancers Reference Weber, 1867 Volkmann, 1870 Fujinami, 1900 Anzinger, 1902 Hartz and van der Sar, 1942 Hassin, 1947 Willis, 1952 Slatkin and Pearson, 1976 Rotterdam and Slavutin, 1981 Primary Cancer Carcinoma invading sternomastoid and pectoral muscles Carcinoma invading pectoral muscle Carcinoma and round cell sarcoma Carcinoma, breast Carcinoma, lip Chloroleukemia (chloroma) Squamous cell carcinoma, esophagus Carcinoma, lung Small cell carcinoma, lung Carcinoma, breast Carcinoma, prostate Urothelial carcinoma, bladder Ewing's sarcoma, bone Adenocarcinoma, breast Burkitt's lymphoma Carcinoma, prostate Squamous cell carcinoma, larynx

Stratton et al, 1982 Lasser and Zacks, 1982 loachim, 1983 Vital et al, 1983 Sarma et al, 1984 (present case)

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an increased development of metastasis and decreased loachim HL: Tumor cells within skeletal muscle cells (letter). Hum Pathol 14:923-924, 1983. survival been noted [Stratton et al, 1982]. It has been Lasser A, Zacks SI: Intraskeletal myofiber metastasis of breast carcirecommended that intramyofiber skeletal muscle invanoma. Hum Pathol 13:1045-1046, 1982. sion should be looked for and reported while examining Rotterdam H, Slavutin L: Secondary tumors of soft tissues: An autopsy study. In Fenoglio CM, Wolff M (eds): "Progress in Surthe cases of Swing's sarcoma with extension into soft gical Pathology," Vol III. New York: Masson Publishing, 1981, tissue [Siegal, 1984]. 147-169. ACKNOWLEDGMENTS We thank Ms. Laura White for excellent secretarial assistance.
Sarma DP, Kovac A, Socorro N: Metastatic carcinoma of the skeletal muscle. South Med J 74:484-485, 1981. Siegal GP: Intramyofiber skeletal muscle invasion in Ewing's sarcoma of bone: Clinicopathologic observations from the intergroup Ewing's sarcoma study (editorial comment). In Brinkhous KM (ed): "The Yearbook of Pathology and Clinical Pathology." Chicago: Yearbook Medical Publishers, 1984, pp 200-201. Slatkin DN, Pearson J: Intramyofiber metastases in skeletal muscle. Hum Pathol 7:347-349, 1976. Stratton B, Askin FB, Kissane J M: Intramyofiber skeletal muscle invasion in Ewing's sarcoma of bone: Clinicopathologic observations from the intergroup Ewing's sarcoma study. Am J Pediatr HematolOncol 4:231-235, 1982. Vital C, Rivel J, Fournier M: Intramyofiber metastases in skeletal muscle (letter). Hum Pathol 14:1012, 1983. Volkmann R: Zur histologic des muskelkrebses. Arch Path Anat 50:543, 1870 (cited by Anzinger, 1902). Weber O: Arch Path Anat 39: 1867 (cited by Anzinger, 1902). Willis RA: "The Spread of Tumors in the Human Body." London: Butterworth and Co., 1952, pp 284-285.

REFERENCES
Anzinger FP: The changes occurring in striped muscle in the neighbourhood of malignant tumors. Am J Med Sci 123:268-284, 1902. Carr I, McGinty F, Norris P: The fine structure of neoplastic invasion: Invasion of liver, skeletal muscle and lymphatic vessels by the Rd/3 tumour. J Pathol 118:91-99, 1966. Fujinami A: Ueber das histologische Verhalten des quergestreiften Muskels an der Grenze bosartiger Geschwulste. Arch Path Anat 16:115-158, 1900. Hartz PH, van der Sar A: Chloroleukemia. Report of a case with special reference to its neoplastic nature. Am J Pathol 18:715-727, 1942. Hassin GB: Carcinoma of muscle tissue as a cause of laryngeal paralysis. J Neuropathol Exp Neurol 6:358-368, 1947.

Sarma DP, Weilbaecher TG, Love GL(1985): Intramyofiber metastasis in skeletal muscle. J Surg Oncol 30:103-105. PMID: 4079421 [PubMed - indexed for MEDLINE]