DISCUSSION:
There is an increasing incidence of malignancy globally; cancer associated morbidity and mortality is major consequence of distant metastasis and advanced stage of disease4. It is estimated that metastasis is responsible for about 90% of cancer deaths. This is a significant reason why cancer management cannot deliver its maximum benefits1, 3. It is necessary to understand the pathogenesis and patterns of metastatic spread. Metastasis is the general term used to describe the spread of cancer cells from the primary tumor to surrounding tissues and to distant organs. Cancers of esophagus and cervix are common and have predictable routes of spread like liver, lung, bones and lymph nodes. Rare sites of metastasis are now being described in the literature1, 3, 5.
Unusual organs where esophageal carcinoma metastatic deposits have been found are head & neck, kidney, pancreas, spleen and very rarely to skin and skeletal muscles1, 2, 5. Physiologically, skeletal muscles are highly resistant to primary and metastatic cancers owing to high contractility, perfusion of blood and high mobility6. In the present case esophageal adenocarcinoma has spread to several skeletal muscles (left triceps brachii, right supraspinatous, posterior abdominal wall muscles and left medial thigh) throughout the body. The fine needle aspiration from triceps muscle showed malignant cells closely associated with skeletal muscle fibres. The core biopsy done from the same site at later date revealed the same findings in histopathology.
Unexpected metastasis from carcinoma cervix includes heart, brain, muscle3, 7. Squamous cell carcinoma of cervix metastasing to thyroid gland is very rare8. Our case of carcinoma cervix showed metastatic deposits to thyroid. The cytology showed malignant squamoid cells admixed with thyroid follicular epithelial cells.
Probable route of spread in both cases is hematogenous. The cytopathological diagnosis in these cases helped the clinicians manage the further course of management accordingly.