Metastases to soft tissue - A review of 118 cases over a 30-year period
Metastases to soft tissue - A review of 118 cases over a 30-year period
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DOI：
10.1002/cncr.23151
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发表时间：
2008-01-01
期刊：
影响因子：
6.2
通讯作者：
Suster, Saul
中科院分区：
文献类型：
--
作者：
Plaza, Jose Antonio;Perez-Montiel, Delia;Suster, Saul
背景转移性肿瘤表现为软组织肿块是相对罕见的，可能是临床和病理诊断混淆的来源。作者回顾了一个大型学术医学中心30年（1971-2000年）软组织转移的经验。研究中的肿瘤主要包括累及上下肢、躯干、肩部和臀部的骨骼肌或骨骼肌和皮下组织的病变。排除了源自骨或邻近器官的肿瘤、累及皮肤或已知含有大量淋巴结的区域（即腋窝、腹股沟）的肿瘤和造血系统恶性肿瘤的直接延伸。确定了118个病例; 60名患者为女性，58名为男性。年龄范围为20至87岁（中位数为53.5岁）。原发肿瘤位于皮肤（19例患者），肺（13例患者），乳腺（13例患者），肾脏（12例患者），结肠和直肠（12例患者），子宫（8例患者），卵巢（5例患者），头部和颈部（舌、咽、喉、鼻腔和下颌骨）（5例患者），食管（2例患者），胃（2例患者），宫颈（2例患者），小肠（2例患者），骨（2例患者）、肾上腺（1例患者）、眼（1例患者）、睾丸（1例患者）、膀胱（1例患者）和唾液腺（1例患者）。27%（32/118）的病例以软组织转移为首发表现。在13.5%（16/118例）的病例中，无法确定原发部位。转移部位包括腹壁（25例患者），背部，包括肩胛区（20例患者），大腿（17例患者），胸壁（15例患者），组（15例患者），肩关节（11例患者），Patient（5例患者）、会阴（3例患者）、腿部（2例患者）、足部（1例患者）、脐部（1例患者）、踝部（1例患者）、头皮（1例患者）和肘部（1例患者）。肿瘤组织学类型：癌83例，恶性黑色素瘤20例，肉瘤和癌肉瘤9例，恶性混合苗勒管瘤2例，腺瘤1例，恶性畸胎瘤1例，恶性胃肠道间质瘤1例，神经母细胞瘤1例。许多肿瘤的组织学特征给诊断带来困难，在常规组织病理学检查中很容易被误认为各种原发性软组织肉瘤。常规使用免疫组化染色有助于正确鉴别。软组织转移并不少见，它们可能代表疾病的最初表现。建议使用一组基本的免疫组化染色来确定细胞类型并达到正确的诊断。
BACKGROUND. Metastatic tumors presenting as soft tissue masses are relatively rare and can be the Source Of diagnostic Confusion both clinically and pathologically. The authors' experience was reviewed at a large academic medical center over a 30-year period (1971-2000) with metastases to soft tissue.METHODS. The tumors in the study included mainly lesions involving skeletal muscle or skeletal Muscle and subcutaneous tissue of the tipper and lower limbs, trunk, shoulders, and buttocks. Direct extension from tumors originating in bone or adjacent organs, tumors involving the skin or areas known to contain abundant lymph nodes (ie, axilla, groin), and hematopoietic malignancies were excluded.RESULTS. one hundred and eighteen cases were identified; 60 patients were women and 58 were men. The age range was 20 to 87 years (median of 53.5 years). The primary tumor was located in the skin (19 patients), lung (13 patients), breast (13 patients), kidney (12 patients), colon and rectum (12 patients), uterus (8 patients), ovary (5 patients), head and neck (tongue, pharynx, larynx, nasal cavity, and mandible) (5 patients), esophagus (2 patients), stomach (2 patients), cervix (2 patients), small bowel (2 patients), bone (2 patients), adrenal gland (I patient), eye (I patient), testis (I patient), urinary bladder (I patient), and salivary gland (1 patient). In 27% (32 of 118 cases) of cases, the soft tissue metastasis was the initial manifestation of the disease. In 13.5% (16 of 118 cases) of cases the primary site of origin could not be identified. The sites of metastasis included the abdominal wall (25 patients), back, including scapular region (20 patients), thigh (17 patients), chest wall (15 patients), arm (15 Patients), Shoulder (11 patients), buttock (5 patients), perineum (3 patients), leg (2 patients), foot (I patient), umbilical area (I patient), ankle (I patient), scalp (I patient), and elbow (I patient). The histologic classification of the tumors included carcinoma (83 patients), malignant melanoma (20 patients), sarcoma and carcinosarcoma (9 patients), malignant mixed Mullerian turner (2 patients), seminoma (I patient), malignant teratoma (I patient), malignant gastrointestinal stromal turner (I patient), and neuroblastoma (I patient). Many Of the tumors displayed histologic features that created difficulties for diagnosis and Could be easily mistaken on routine histopathologic examination for a variety of primary soft-tissue sarcomas. Routine use of immunohistochemical stains aided in their proper recognition.CONCLUSIONS. Metastases are not in infrequent finding in soft tissue and they may represent the initial manifestation of the disease. Use of a basic panel of immunohistochemical stains is recommended for defining the cell type and arriving at the correct diagnosis.