Symptomatic skeletal muscle metastasis and elephantiastic lymphedema in a patient with recurrent ovarian carcinoma

Background. Distant tumor metastases in ovarian cancer patients in striated muscles are extremely rare. So far, only one case of metastatic but asymptomatic spread to striated muscle has been described. Case. A patient with recurrent ovarian carcinoma presented with a gluteal mass I week following optimal debulking surgery. CT and MRI initially suggested muscle necrosis or intramuscular bleeding. Increasing pain and massive lymphedema led to immobilization and clinical deterioration. Repeated ultrasound and CT-guided biopsy confirmed the diagnosis of skeletal muscle metastases. Conclusion. This is the first case description of distant skeletal muscle metastasis as the leading clinical symptom of late stage ovarian carcinoma. It reveals possible limitations of CT and MRI as diagnostic tools for early identification of striated muscle metastases. (C) 2003 Elsevier Science (USA). All rights reserved.