INTRODUCTION:
Adenocarcinoma of oesophagus and Squamous cell carcinoma of cervix are common malignancies presenting typically and having predictable routes of metastasis1, 2, 3. Following cases show unusual sites of spread, not congruent with present knowledge of metastasis.
CASE 1: A sixty seven year old male presented to the hospital with a mass in left upper arm for one month. Since the patient was a known case of adenocarcinoma oesophagus (diagnosed two years back), he was advised ultrasonography, CT scan and PET. PET scan revealed FDG avid intramuscular deposits in left triceps brachii, right supraspinatous, posterior abdominal wall muscles and left medial thigh muscles (Fig. I). USG guided fine needle aspiration was done from PET positive mass in left triceps muscle to rule out soft tissue malignancy developing post chemo and radiotherapy. The aspirate smears were cellular and were reported as positive for malignant cells, poorly differentiated adenocarcinoma, consistent with metastasis (Fig. II). Soon after, a USG guided trucut biopsy was also done from the same site. Histopathology confirmed metastatic adenocarcinoma in triceps muscle (Fig. II inset).
CASE 2: Forty three year female presented with a nodule in left thyroid lobe. A diagnosis of poorly differentiated carcinoma was given on the FNA smears of thyroid. Detailed clinical history revealed that she was a known case of poorly differentiated squamous cell carcinoma, cervix. On review of slides focal areas showed squamoid differentiation (Fig. III).