Journal List > J Korean Soc Radiol > v.78(5) > 1095537

Park, Lee, Song, Park, Lee, Yi, and Song: Soft Tissue Metastasis in Patients with Primary Malignancies; Magnetic Resonance Imaging and Clinical Evaluations

Abstract

Purpose

The purpose of this study was to evaluate the clinical and magnetic resonance imaging (MRI) findings of soft tissue metastases distinct from benign soft tissue lesions.

Materials and Methods

We retrospectively analyzed the MRI findings of soft tissue lesions found incidentally in patients with primary carcinoma and those without primary carcinoma from 2002–2015. To evaluate the features of soft tissue metastases distinct from benign soft tissue lesions, patients with benign soft tissue lesions were randomly selected and statistically analyzed for the distinctive features of the two groups.

Results

A total of 47 patients (mean age 46.2 years) and 36 controls (mean age 46.2 years) were enrolled. Thirty six of the 47 patients were diagnosed with soft tissue metastasis, most commonly as the primary cancer (31%). The most common site of soft tissue metastasis was the lower extremities (36%) followed by the upper extremities (31%). Soft tissue metastasis was statistically significantly different from benign soft tissue lesions according to patient age, lesion size, margin, presence of degenerative changes in lesions, and presence of edema around the mass.

Conclusion

If the incident soft tissue lesion shows malignant features on MRI in patients with primary carcinoma or in patients over 40 years of age, the radiologist should consider the possibility of metastatic cancer.

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Fig. 1.
A 50-year-old male patient diagnosed with oropharyngeal cancer two years previously and presently complaining of buttock pain. A. On coronal fat-suppressed T2-weighted image of the pelvis, a hyperintense soft tissue lesion with ill-defined margin (arrow) is seen in the muscular layer of the right buttock. Peritumoral edema (arrowheads) is also noted. B. The lesion shows homogeneous enhancement without degenerative change within the lesion (arrow) on axial fat-suppressed, contrast-enhanced T1-weighted image.
jksr-78-321f1.tif
Fig. 2.
A 47-year-old male patient with multiple bone and soft tissue lesions. After biopsy for soft tissue lesion, lung cancer was diagnosed. A. On coronal fat-suppressed T2-weighted image of pelvis, two heterogeneous soft tissue masses with peritumoral edema are seen within each iliopsoas (arrow) and adductor muscle (arrowhead). B. On another scan of same sequence, multiple bone metastatic lesions are seen (arrows). C. Metastatic mass located within the right iliopsoas muscle shows degenerative change (arrow) on axial fat-suppressed contrast enhanced T1-weighted image.
jksr-78-321f2.tif
Fig. 3.
A 67-year-old male patient with intramuscular metastasis and unknown lung cancer. A. On axial T1-weighted magnetic resonance image of left thigh, a homogeneous mass lesion (arrows) is seen in the semitendinosus muscle. B. The soft tissue lesion (arrows) shows well-defined margin without peritumoral edema on axial fat-suppressed T2-weighted image. C. On sagittal fat-suppressed, contrast-enhanced T1-weighted image, the mass lesion (arrows) shows homogeneous enhancement without degenerative change.
jksr-78-321f3.tif
Table 1.
The Types of Primary Malignancies and the Number of Patients Diagnosed with Soft Tissue Metastasis According to Each Primary Malignancy
Primary Malignancy Number of Patients Soft Tissue Metastasis
Lung cancer 12 11
Breast cancer 6 2
Thyroid cancer 5 2
Colorectal cancer 5 5
Stomach cancer 2 2
Hepatocellular cell carcinoma 2 2
Oropharyngeal cancer 2 0
Melanoma 2 2
Cholangiocarcinoma 2 2
Bowen's disease 1 1
(Squamous cell cancer in situ)    
Hemangiopericytoma 1 1
Renal cell carcinoma 1 1
Gall bladder cancer 1 1
Uterine cervical cancer 1 1
Plasmacytoma (multiple myeloma) 1 0
Unknown origin 3 3
Total 47 36
Table 2.
The Anatomical Locations of Soft Tissue Lesions
Locations Metastasis Control Group
Neck area 0 3
Shoulder 6 0
Upperarm 2 5
Elbow 1 0
Forearm 1 1
Finger/hand/wrist 1 6
Pelvic area 4 3
Thigh 7 4
Lower leg 6 5
Ankle 0 1
Toe 0 2
Back area (muscle & subcutaneous fat) 1 4
Psoas muscle 3 2
Chest wall 3 0
Abdominal wall 1 0
Total 36 36

The location of one new malignant tumor (myxofibrosarcoma) was thigh.

Table 3.
Clinical and Magnetic Resonance Imaging Analysis Results for Differentiating between Soft Tissue Metastasis and Benign Soft Tissue Lesion
  Soft Tissue Metastasis Benign Lesion p-Value
Age (years) 62.83 ± 2.45 46.22 ± 3.05 < 0.0001
Gender (M:F) 21:15 17:19 0.348
Size (cm) 7.5 (2.8–26) 3.5 (0.4–11.6) 0.001
Symptom n = 11 n = 14 0.461
Location (deep: superficial) 30:6 25:11 0.168
Margin (well:ill) 10:26 32:4 < 0.0001
Homogeneity 16 11 0.227
Degenerative change within the mass 16 8 0.047
Bone erosion 6 5 0.745
Peritumoral edema 28 8 < 0.0001
Mineralization 2 2 1
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