대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제78권5호
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  • Pages.321-329
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  • 2018
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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원발암이 있는 환자에서 연조직 전이; 자기공명영상과 임상적 평가

Soft Tissue Metastasis in Patients with Primary Malignancies; Magnetic Resonance Imaging and Clinical Evaluations

  • 박소민 (부산대학교병원 의생명연구원 영상의학과) ;
  • 이인숙 (부산대학교병원 의생명연구원 영상의학과) ;
  • 송유선 (부산대학교병원 의생명연구원 영상의학과) ;
  • 박신영 (부산대학교병원 의생명연구원 영상의학과) ;
  • 이호석 (경북대학교병원 영상의학과) ;
  • 이재혁 (계명대학교 동산의료원 영상의학과) ;
  • 송종운 (인제대학교 부산해운대백병원 영상의학과)
  • Park, So Min (Department of Radiology, Pusan National University Hospital Biomedical Research Institute) ;
  • Lee, In Sook (Department of Radiology, Pusan National University Hospital Biomedical Research Institute) ;
  • Song, You Seon (Department of Radiology, Pusan National University Hospital Biomedical Research Institute) ;
  • Park, Shin Young (Department of Radiology, Pusan National University Hospital Biomedical Research Institute) ;
  • Lee, Hoseok (Department of Radiology, Kyungpook National University Hospital) ;
  • Yi, Jae Hyuck (Department of Radiology, Keimyung University, Dongsan Medical Center) ;
  • Song, Jong Woon (Department of Radiology, Inje University Haeundae Paik Hospital)
  • 투고 : 2017.06.23
  • 심사 : 2017.11.02
  • 발행 : 2018.05.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 본 연구는 양성 연조직 병변과 구분되는 연조직 전이의 임상 소견과 자기공명영상 소견을 찾고자 한다. 대상과 방법: 2002~2015년 동안 원발암이 있는 환자 및 원발암을 모르고 있던 환자에서 우연히 발견된 연조직 병변의 자기공명영상소견을 후향적으로 분석하였다. 양성 연조직 병변과 구분되는 연조직 전이의 특징을 평가하기 위해 같은 기간 내 진단된 양성 연조직 병변 대조군을 무작위로 선정하였고, 두 군의 구별되는 특징에 대해 통계학적으로 분석하였다. 결과: 총 47명(평균연령 60.7세)의 환자와 대조군 36명(평균연령 46.2세)을 본 연구에 포함하였다. 47명 중에 36명이 연조직 전이로 진단되었다. 전체 연조직 전이 중 원발암이 폐암인 경우가 가장 많았다(31%). 연조직 전이의 가장 흔한 위치는 하지(36%)였으며, 다음으로는 상지(31%)였다. 연조직 전이는 나이, 병변의 크기, 경계, 병변 내 퇴행성 변화의 유무, 종괴주위 부종의 유무에서 양성 연조직 병변과 통계학적으로 유의한 차이를 보였다. 결론: 원발암이 있거나 혹은 원발암의 존재를 모르고 있는 40세 이상의 환자에서, 우연히 발견된 연조직 병변이 자기공명영상에서 악성의 특징을 보일 때, 영상의학과 의사는 전이암의 가능성을 생각해야 한다.

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.

키워드

참고문헌

  1. Torigoe T, Terakado A, Suehara Y, Okubo T, Takagi T, Kaneko K, et al. Metastatic soft tissue tumors. J Cancer Ther 2011; 5:746-751
  2. Plaza JA, Perez-Montiel D, Mayerson J, Morrison C, Suster S. Metastases to soft tissue: a review of 118 cases over a 30-year period. Cancer 2008;112:193-203 https://doi.org/10.1002/cncr.23151
  3. Sudo A, Ogihara Y, Shiokawa Y, Fujinami S, Sekiguchi S. Intramuscular metastasis of carcinoma. Clin Orthop Relat Res 1993;296:213-217
  4. Pearson CM. Incidence and type of pathologic alterations observed in muscle in a routine autopsy survey. Neurology 1959;9:757-766 https://doi.org/10.1212/WNL.9.11.757
  5. Viswanathan N, Khanna A. Skeletal muscle metastasis from malignant melanoma. Br J Plast Surg 2005;58:855-858 https://doi.org/10.1016/j.bjps.2004.12.001
  6. Herring CL Jr, Harrelson JM, Scully SP. Metastatic carcinoma to skeletal muscle. a report of 15 patients. Clin Orthop Relat Res 1998;355:272-281 https://doi.org/10.1097/00003086-199810000-00029
  7. Sridhar KS, Rao RK, Kunhardt B. Skeletal muscle metastases from lung cancer. Cancer 1987;59:1530-1534 https://doi.org/10.1002/1097-0142(19870415)59:8<1530::AID-CNCR2820590824>3.0.CO;2-H
  8. Stulc JP, Petrelli NJ, Herrera L, Lopez CL, Mittelman A. Isolated metachronous metastases to soft tissues of the buttock from a colonic adenocarcinoma. Dis Colon Rectum 1985;28:117-121 https://doi.org/10.1007/BF02552661
  9. Yoshioka H, Itai Y, Niitsu M, Fujiwara M, Watanabe T, Satomi H, et al. Intramuscular metastasis from malignant melanoma: MR findings. Skeletal Radiol 1999;28:714-716 https://doi.org/10.1007/s002560050579
  10. Tochigi H, Nakao Y, Horiuchi Y, Toyama Y. Metastatic malignant melanoma in the hand muscle--a case report. Hand Surg 2000;5:69-72 https://doi.org/10.1142/S0218810400000156
  11. Williams JB, Youngberg RA, Bui-Mansfield LT, Pitcher JD. MR imaging of skeletal muscle metastases. AJR Am J Roentgenol 1997;168:555-557 https://doi.org/10.2214/ajr.168.2.9016246
  12. Chand M, Thomas RJ, Dabbas N, Bateman AC, Royle GT. Soft tissue metastases as the first clinical manifestation of squamous cell carcinoma of the esophagus: case report. World J Oncol 2010;1;135-137
  13. Damron TA, Heiner J. Distant soft tissue metastases: a series of 30 new patients and 91 cases from the literature. Ann Surg Oncol 2000;7:526-534 https://doi.org/10.1007/s10434-000-0526-7
  14. Seely S. Possible reasons for the high resistance of muscle to cancer. Med Hypotheses 1980;6:133-137 https://doi.org/10.1016/0306-9877(80)90079-1
  15. Fidler IJ, Hart IR. Principles of cancer biology, biology of cancer metastasis. In: Devita VT, Hellman S, Rosenberg SA, eds. Cancer: principles and practice of oncology. Philadelphia: JB Lippincortt 1982:80-92
  16. Acinas Garcia O, Fernandez FA, Satue EG, Buelta L, Val-Bernal JF. Metastasis of malignant neoplasms to skeletal muscle. Rev Esp Oncol 1984;31:57-67
  17. Pretorius ES, Fishman EK. Helical CT of skeletal muscle metastases from primary carcinomas. AJR Am J Roentgenol 2000;174:401-404 https://doi.org/10.2214/ajr.174.2.1740401
  18. Glockner JF, White LM, Sundaram M, McDonald DJ. Unsuspected metastases presenting as solitary soft tissue lesions: a fourteen-year review. Skeletal Radiol 2000;29:270-274 https://doi.org/10.1007/s002560050606
  19. Tuoheti Y, Okada K, Osanai T, Nishida J, Ehara S, Hashmoto M, et al. Skeletal muscle metastases of carcinoma: a clinicopahtological study of 12 cases. Jpn J Clin Oncol 2004;34: 210-214 https://doi.org/10.1093/jjco/hyh036
  20. Torosian MH, Botet JF, Paglia M. Colon carcinoma metastatic to the thigh--an unusual site of metastasis. report of a case. Dis Colon Rectum 1987;30:805-808 https://doi.org/10.1007/BF02554632
  21. Bibi C, Benmeir P, Maor F, Sagi A. Hand metastasis from renal cell carcinoma with no bone involvement. Ann Plast Surg 1993;31:377-378 https://doi.org/10.1097/00000637-199310000-00017
  22. Laurence AE, Murray AJ. Metastasis in skeletal muscle secondary to carcinoma of the colon--presentation of 2 cases. Br J Surg 1970;57:529-530 https://doi.org/10.1002/bjs.1800570712
  23. McKeown PP, Conant P, Auerbach LE. Squamous cell carcinoma of the lung: an unusual metastasis to pectoralis muscle. Ann Thorac Surg 1996;61:1525-1526 https://doi.org/10.1016/0003-4975(95)01177-3
  24. Alburquerque TL, Ortin A, Cacho J. Metastasis in deep calf muscles as first manifestation of bronchus adenocarcinoma. Am J Med 1987;83:606-607
  25. Stoller DW, Steinkirchner TM, Porter B. Bone and soft-tissue tumors. In: Stoller DW, eds. Magnetic resonance imaging in orthopaedics and sports medicine, 1st ed. Philadelphia: Lippincott 1993:1094-1116
  26. Mignani G, McDonald DJ, Boriani S, Avella M, Gaiani L, Campanacci M. Soft tissue metastasis from carcinoma. a case report. Tumori 1989;75:630-633 https://doi.org/10.1177/030089168907500624
  27. Schultz SR, Bree RL, Schwab RE, Raiss G. CT detection of skeletal muscle metastases. J Comput Assist Tomogr 1986; 10:81-83 https://doi.org/10.1097/00004728-198601000-00018
  28. O'Keefe D, Gholkar A. Metastatic adenocarcinoma of the paraspinal muscles. Br J Radiol 1988;61:849-851 https://doi.org/10.1259/0007-1285-61-729-849
  29. Munk PL, Gock S, Gee R, Connell DG, Quenville NF. Case report 708: metastasis of renal cell carcinoma to skeletal muscle (right trapezius). Skeletal Radiol 1992;21:56-59
  30. Kransdorf MJ, Jelinek JS, Moser RP Jr, Utz JA, Brower AC, Hudson TM, et al. Soft-tissue masses: diagnosis using MR imaging. AJR Am J Roentgenol 1989;153:541-547 https://doi.org/10.2214/ajr.153.3.541