title: Metastasis of gastrointestinal stromal tumor to skeletal muscle: a case report.
abstract: BACKGROUND
  Gastrointestinal stromal tumor is the most common malignant mesenchymal tumor of the gastrointestinal tract. The most common sites of metastasis are the liver and the peritoneum, but gastrointestinal stromal tumors rarely metastasize to the skeletal muscles. Only three cases of gastrointestinal stromal tumor metastasizing to skeletal muscle have been reported in the English literature. Here we present an additional case of skeletal muscle metastasis, and the relevant literature is reviewed.
  
  
  METHODS
  A 54-year-old Japanese man presented with a three-month history of an enlarging mass of the left buttock. An excisional biopsy was performed and the tumor was diagnosed as a leiomyosarcoma. However, careful examination of the gastrointestinal tract revealed a tumor located in the small intestine. Surgical resection of the small intestine tumor was performed; histopathological and immunohistochemical examinations identified it as a primary gastrointestinal stromal tumor arising from the small intestine. Despite receiving both chemotherapy and molecular-targeted therapy, our patient died of gastrointestinal bleeding six months after the initial diagnosis.
  
  
  CONCLUSIONS
  Because it is a mesenchymal tumor, it is difficult to distinguish a gastrointestinal stromal tumor metastasis to skeletal muscle from other primary soft tissue sarcomas. Although metastasis of gastrointestinal stromal tumor to skeletal muscle is rare, the likelihood of finding metastases in these unusual sites is increasing due to prolonged survival of patients with gastrointestinal stromal tumor after the introduction of imatinib therapy. We should include metastases of gastrointestinal stromal tumors as differential diagnosis of spindle cell tumor, and it is necessary to begin appropriate treatment early.
authors.forename: Kayo
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Orthopaedic Surgery, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194, Japan. yasuda@med.u-toyama.ac.jp.
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Yasuda
authors.forename: Kaoru
authors.initials: K
authors.lastname: Nagao
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hori
authors.forename: Kenta
authors.initials: K
authors.lastname: Watanabe
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kanamori
authors.forename: Tomoatsu
authors.initials: T
authors.lastname: Kimura
mesh_terms: D002081:Buttocks; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis / Q000556:secondary*; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000175:diagnosis / Q000556:secondary*; D052097:Quadriceps Muscle / Q000473:pathology*