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Malignant Psoas Syndrome Demonstrated by PET/CT in the Context of Metastatic Non Small Cell Lung Cancer

Received: 26 July 2021    Accepted: 4 August 2021    Published: 18 August 2021
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Abstract

The significant cancer pain syndrome of malignant psoas syndrome (MPS), was first reported as a neurooncologic occurrence in 1990. The Syndrome is characterised by malignant infiltration of a psoas muscle, either directly or by involvement with haematogenously disseminated metastatic cancer. Direct involvement has been from primary tumours of the psoas muscle, or by extension from malignant paraaortic lymphadenopathy. Treatment is difficult, complex analgesia is essential, and benefits have been achieved from chemotherapy, radiotherapy and in select cases, surgery. Here, the case of a 60 year old female who presented with three months of moderate dyspnoea, low back and left inguinal region pain/numbness and lassitude, is reported. Chest radiograph and CT showed a large anterior mediastinal mass. FDG PET/CT revealed the mass to be intensely avid, with heterogeneous central areas of photopaenia. Avid lymphadenopathy was also present in two mediastinal nodal stations. Subdiaphragmatically, there was a metabolically FDG avid soft tissue mass in the superior part of the left psoas muscle, presumably accounting for her pain. There was no FDG avidity elsewhere. Core biopsy of the psoas mass revealed adenocarcinoma of probable lung origin. The patient responded symptomatically to intermediate dose radiation therapy. The pathophysiology of MPS is discussed and the range of cancer types associated with the Syndrome is updated.

Published in International Journal of Clinical Oncology and Cancer Research (Volume 6, Issue 3)
DOI 10.11648/j.ijcocr.20210603.17
Page(s) 141-144
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Malignant Psoas Syndrome, MPS, PET/CT, Non Small-cell Lung Cancer

References
[1] Stevens MJ and Gonet YM. Malignant psoas syndrome: recognition of an oncologic entity. Australas Radiol. 1990; 34: 150-154.
[2] McKay TA, Bishop S, McKay MJ. Primary psoas sarcoma causing malignant psoas syndrome: favourable response to radiotherapy. Ann Transl Med. 2017; 5: 105-108.
[3] Gerontopoulos A, Mosa E, Alongi F et al. Impact of Radiation Therapy on Pain Relief of Cancer Patients Affected by Malignant Psoas Syndrome: 26 Years of Experience. Indian J Palliat Care. 2020; 26: 348-351.
[4] Stevens MJ, Atkinson C, Broadbent AM. The malignant psoas syndrome revisited: case report, mechanisms and current therapeutic options. J Palliat Med. 2010; 13: 211-216.
[5] Basu S, Mahajan A. Psoas muscle metastasis from cervical carcinoma: Correlation and comparison of diagnostic features on FDG-PET/CT and diffusion-weighted MRI. World J Radiol. 2014; 6: 125-129.
[6] Ota T, Makihara M, Tsukuda H et al. Pain Management of Malignant Psoas Syndrome Under Epidural Analgesia During Palliative Radiotherapy. J Pain Palliat Care Pharmacother. 2017; 31: 154-157.
[7] Takamatsu S, Murakami K, Takaya H. Malignant psoas syndrome associated with gynecological malignancy: Three case reports and a review of the literature. Mol Clin Oncol. 2018 Jul; 9 (1): 82-86.
[8] Mollica M, Maffucci R, Lavoretano S et al. Non-small cell lung cancer presenting as "psoas muscle syndrome". Monaldi Arch Chest Dis. 2019; 89.
[9] Tsuchiyama K, Ito H, Seki M et al. Advanced bladder cancer with malignant psoas syndrome: A case report with a focus on physical findings and complications. Urol Case Rep. 2019; 26: 100958.
[10] Yamaguchi T, Katayama K, Matsumoto M. Successful Control of Pain from Malignant Psoas Syndrome by Spinal Opioid with Local Anesthetic Agents. Pain Pract. 2018; 18: 641-646.
[11] Kharbach Y, Alaoui SR, Khallouk A. Ovarian adenocarcinoma metastasis mimicking psoas abscess on imaging: a case report. Pan Afr Med J. 2020 Jul 29; 36: 231.
[12] Pearson CM. Incidence and type of pathologic alterations observed in muscle in a routine autopsy survey. Neurology. 1959; 9: 757-766.
[13] Razak AR, Chhabra R and Hughes A. Muscular metastasis, a rare presentation of non-small-cell lung cancer. Med Gen Med. 2007; 9: 20-25.
[14] The psoas muscle. Wikipedia.
[15] Jaeckle K. Nerve plexus lesions. Neurol Clin. 1991; 9: 857-866.
[16] Lievens Y, Guckenberger, M, Gomez D et al. Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document. Radiother Oncol. 2020; 148: 157-66.
[17] Agar M, Broadbent A, Chye R. The management of malignant psoas syndrome: case reports and literature review. J Pain Symptom Manage. 2004; 28: 282-293.
Cite This Article
  • APA Style

    Michael Jerome McKay, Aaron Chindewere, Laura Wise, Fraser Brown, Kim Louise Taubman, et al. (2021). Malignant Psoas Syndrome Demonstrated by PET/CT in the Context of Metastatic Non Small Cell Lung Cancer. International Journal of Clinical Oncology and Cancer Research, 6(3), 141-144. https://doi.org/10.11648/j.ijcocr.20210603.17

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    ACS Style

    Michael Jerome McKay; Aaron Chindewere; Laura Wise; Fraser Brown; Kim Louise Taubman, et al. Malignant Psoas Syndrome Demonstrated by PET/CT in the Context of Metastatic Non Small Cell Lung Cancer. Int. J. Clin. Oncol. Cancer Res. 2021, 6(3), 141-144. doi: 10.11648/j.ijcocr.20210603.17

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    AMA Style

    Michael Jerome McKay, Aaron Chindewere, Laura Wise, Fraser Brown, Kim Louise Taubman, et al. Malignant Psoas Syndrome Demonstrated by PET/CT in the Context of Metastatic Non Small Cell Lung Cancer. Int J Clin Oncol Cancer Res. 2021;6(3):141-144. doi: 10.11648/j.ijcocr.20210603.17

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  • @article{10.11648/j.ijcocr.20210603.17,
      author = {Michael Jerome McKay and Aaron Chindewere and Laura Wise and Fraser Brown and Kim Louise Taubman and Timothy Michael McKay},
      title = {Malignant Psoas Syndrome Demonstrated by PET/CT in the Context of Metastatic Non Small Cell Lung Cancer},
      journal = {International Journal of Clinical Oncology and Cancer Research},
      volume = {6},
      number = {3},
      pages = {141-144},
      doi = {10.11648/j.ijcocr.20210603.17},
      url = {https://doi.org/10.11648/j.ijcocr.20210603.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcocr.20210603.17},
      abstract = {The significant cancer pain syndrome of malignant psoas syndrome (MPS), was first reported as a neurooncologic occurrence in 1990. The Syndrome is characterised by malignant infiltration of a psoas muscle, either directly or by involvement with haematogenously disseminated metastatic cancer. Direct involvement has been from primary tumours of the psoas muscle, or by extension from malignant paraaortic lymphadenopathy. Treatment is difficult, complex analgesia is essential, and benefits have been achieved from chemotherapy, radiotherapy and in select cases, surgery. Here, the case of a 60 year old female who presented with three months of moderate dyspnoea, low back and left inguinal region pain/numbness and lassitude, is reported. Chest radiograph and CT showed a large anterior mediastinal mass. FDG PET/CT revealed the mass to be intensely avid, with heterogeneous central areas of photopaenia. Avid lymphadenopathy was also present in two mediastinal nodal stations. Subdiaphragmatically, there was a metabolically FDG avid soft tissue mass in the superior part of the left psoas muscle, presumably accounting for her pain. There was no FDG avidity elsewhere. Core biopsy of the psoas mass revealed adenocarcinoma of probable lung origin. The patient responded symptomatically to intermediate dose radiation therapy. The pathophysiology of MPS is discussed and the range of cancer types associated with the Syndrome is updated.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Malignant Psoas Syndrome Demonstrated by PET/CT in the Context of Metastatic Non Small Cell Lung Cancer
    AU  - Michael Jerome McKay
    AU  - Aaron Chindewere
    AU  - Laura Wise
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    DO  - 10.11648/j.ijcocr.20210603.17
    T2  - International Journal of Clinical Oncology and Cancer Research
    JF  - International Journal of Clinical Oncology and Cancer Research
    JO  - International Journal of Clinical Oncology and Cancer Research
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    EP  - 144
    PB  - Science Publishing Group
    SN  - 2578-9511
    UR  - https://doi.org/10.11648/j.ijcocr.20210603.17
    AB  - The significant cancer pain syndrome of malignant psoas syndrome (MPS), was first reported as a neurooncologic occurrence in 1990. The Syndrome is characterised by malignant infiltration of a psoas muscle, either directly or by involvement with haematogenously disseminated metastatic cancer. Direct involvement has been from primary tumours of the psoas muscle, or by extension from malignant paraaortic lymphadenopathy. Treatment is difficult, complex analgesia is essential, and benefits have been achieved from chemotherapy, radiotherapy and in select cases, surgery. Here, the case of a 60 year old female who presented with three months of moderate dyspnoea, low back and left inguinal region pain/numbness and lassitude, is reported. Chest radiograph and CT showed a large anterior mediastinal mass. FDG PET/CT revealed the mass to be intensely avid, with heterogeneous central areas of photopaenia. Avid lymphadenopathy was also present in two mediastinal nodal stations. Subdiaphragmatically, there was a metabolically FDG avid soft tissue mass in the superior part of the left psoas muscle, presumably accounting for her pain. There was no FDG avidity elsewhere. Core biopsy of the psoas mass revealed adenocarcinoma of probable lung origin. The patient responded symptomatically to intermediate dose radiation therapy. The pathophysiology of MPS is discussed and the range of cancer types associated with the Syndrome is updated.
    VL  - 6
    IS  - 3
    ER  - 

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Author Information
  • Departments of Radiation and Medical Oncology, North West Cancer Centre, Burnie, Australia

  • Departments of Radiation and Medical Oncology, North West Cancer Centre, Burnie, Australia

  • Northern Tasmanian Pathology Service, Launceston General Hospital, Launceston, Australia

  • I-Med Medical Imaging, Launceston General Hospital, Launceston, Australia

  • Department of Medical Imaging, St Vincents Hospital, Melbourne, Australia

  • Department of Precision Medicine, Monash University, Melbourne, Australia

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