J Korean Soc Radiol.  2013 May;68(5):427-430.

Inflammatory Metastatic Carcinoma of Sternum Mimicking Sternal Osteomyelitis with Gas Gangrene

• Choo JY
• Je BK
• Kim SB
• Lee KY
• Kim BH

Abstract

Inflammatory metastasis is a metastatic tumor associated with fever, skin changes, soft tissue inflammation, and laboratory abnormalities, suggesting an inflammation that obscures the underlying malignancy. We report a 69-year-old male with inflammatory metastatic carcinoma of sternum. He presented with clinical findings mimicking osteomyelitis of the sternum. The chest CT scan showed the parasternal soft tissue masses and cortical disruption of sternum which was continuous with air bubbles spreading through the pectoralis muscles. He was diagnosed as poorly-differentiated carcinoma with unknown origin.

MeSH Terms

Carcinoma, Squamous Cell
Fever
Gas Gangrene
Humans
Inflammation
Male
Multidetector Computed Tomography
Neoplasm Metastasis
Osteomyelitis
Pectoralis Muscles
Skin
Sternum
Thorax

Figure

• 

  Fig. 1 A 69-year-old man who suffered from fever and pain in his anterior chest wall. A. Soft tissue surrounding sternum is enhanced. Sternal marrow cavity is also enhanced, and cortical disruption was evident. Gas was spread through the pectoralis muscles to the axilla, bilaterally. These findings are interpreted as sternal osteomyelitis with gas gangrene. B. At the level of the 3rd costosternal junction, lobular shape, hyperdense, soft tissue masses are suspected anterior to the sternum (arrow), and infiltrated into the marrow cavity of the sternum and retrosternal space. C. High power field (× 400) of the specimen from parasternal soft tissue containes poorly-differentiated carcinoma, most likely squamous cell carcinoma. D. Whole body positron emission tomography-CT demonstrates multiple bone metastasis to the axial skeleton, including the spine, rib, pelvis, and skull base, as well as intra-abdominal nodal metastasis around the prostate.

Reference

1. Bachmeyer C, Langman B, Kazerouni F, Charoud A, Mougeot-Martin M. Inflammatory sternal metastasis heralding lung cancer: two cases. Clin Rheumatol. 2006. 25:409–411.

2. Thongngarm T, Lemos LB, Lawhon N, Harisdangkul V. Malignant tumor with chest wall pain mimicking Tietze's syndrome. Clin Rheumatol. 2001. 20:276–278.

3. Mirza NN, McCloud JM, Cheetham MJ. Clostridium septicum sepsis and colorectal cancer - a reminder. World J Surg Oncol. 2009. 7:73.

4. Schaaf RE, Jacobs N, Kelvin FM, Gallis HA, Akwari O, Thompson WM. Clostridium septicum infection associated with colonic carcinoma and hematologic abnormality. Radiology. 1980. 137:625–627.

5. Cox SE, Cruz PD Jr. A spectrum of inflammatory metastasis to skin via lymphatics: three cases of carcinoma erysipeloides. J Am Acad Dermatol. 1994. 30(2 Pt 2):304–307.

6. Toussirot E, Gallinet E, Augé B, Voillat L, Wendling D. Anterior chest wall malignancies. A review of ten cases. Rev Rhum Engl Ed. 1998. 65:397–340.

7. Jurik AG. Anterior chest wall involvement in seronegative arthritides. A study of the frequency of changes at radiography. Rheumatol Int. 1992. 12:7–11.