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.