Metastatic gastroesophageal adenocarcinoma to skeletal muscle: a unique event

Skeletal muscle is rarely the site of metastatic cancer, though a few such cases have been reported. Esophageal adenocarcinoma metastasic to skeletal muscle has not previously been reported in the literature. We describe the case of 71-year-old African American male with stage IV adenocarcinoma of the gastroesophageal junction. He had severe and disabling pain in the right thigh, which was tender to palpation. The pain was unresponsive to nonsteroidal anti-inflammatory drugs and full-dose narcotics. Plain x-ray films and bone scan were nondiagnostic. Magnetic resonance imaging showed a soft tissue mass involving the thigh muscles, anterior and medial to the right femur. Computed tomography (CT)-guided biopsy revealed that the thigh mass was metastatic adenocarcinoma consistent with the primary gastroesophageal cancer. Metastasis to muscle is rare, but physicians should be aware of the possibility because detection requires specific tests. We discuss the role of these tests, as well as available treatment options.