Lung cancer metastasis mimicking gluteal abscess.

To the Editor: Lung cancer is one of the most commonly diagnosed cancers in both men and women worldwide. The most common metastatic sites encountered in patients with nonsmall cell carcinoma are the pleura, central nervous system, liver, adrenal glands, and skeletal system. (1) It is unusual for it to present in the form of musculoskeletal abscess.

A 50-year-old man presented with a 5 X 5 X 6 cm mass in the upper lobe of the left lung, discovered using thorax computed tomography (CT). The results of bronchoscopic biopsy showed adenocarcinoma of the lung. No distant metastasis was found in the staging procedure, and it was diagnosed as stage IIIB. He was treated with concurrent chemotherapy by cisplatin and gemcitabine. Ten days after the third chemotherapy treatment, he was admitted to the emergency room with high body temperature and pain at the gluteal region. On rectal digital examination, an anal mass was palpated. A full blood count showed the hemoglobin value to be 12.2 gr/dL, white blood cells 15.9 X [10.sup.3] and the platelets 230 X [10.sup.3]/L. Magnetic resonance imaging (MRI) was undertaken. MRI showed on the right side of the pelvis a 5 X 5 cm lesion. It was thought to be an anal abscess, and abscess drainage was performed. The fluid culture results were completely negative. Cytology of the fluid was positive for malignancy, especially adenocarcinoma metastasis.

The patient presented here was unusual because the gluteal spreading of lung cancer is rare. To the best of our knowledge, there is only one case like this in the literature that was metastatic at the time of diagnosis. (2) This case report reveals an important learning point: in cancer patients, atypical metastases such as an abscess should be kept in mind.

Ibrahim Tek, MD*

Ozlem Turhan Iyidir, MD[dagger]

Gungor Utkan, MD*

Koray Ceyhan, MD[double dagger]

Abdullah Buyukcelik, MD*

Bulent Yalcin, MD*

Ahmet Demirkazik, MD*

Departments of *Medical Oncology, [dagger]Internal Medicine, and [double dagger]Pathology

Ankara University, School of Medicine

Ankara, Turkey.

References

1. Schuchert MJ, Luketich JD. Solitary sites of metastatic disease in non-small cell lung cancer. Curr Treat Options Oncol 2003;4:65-79.

2. Srikanth B, Sankar NS, Kong KC, et al. Lessons to be learned: a case study approach: metastatic bronchogenic carcinoma presenting as a gluteal abscess. J R Soc Health 1999;119:264-267.