Urinary bladder carcinoma is a common malignancy worldwide. The metastatic disease to distant organs including lung, liver, and bone is well established. However, metastasis to below-knee-level; also known as acrometastasis is a rare occurrence and occurs approximately 0.1% of all bone metastases. It is standard of care to obtain a contrast enhanced computed tomography scan of the chest, abdomen, and pelvis for pretreatment planning, primary staging, and post treatment disease surveillance. This makes the occurrence of acrometastasis harder to detect and may only manifest clinically in advance disease. We report a case of 55 years old gentleman treated as muscle-invasive bladder urothelial carcinoma, presented with chronic left knee pain, and imaging demonstrating tumor in the left knee region. Histopathologic study shows features of metastatic disease from urinary bladder carcinoma to the left gastrocnemius muscle. The attending physician should raise the suspicion of metastatic disease if the patient with known malignancy presented with new soft tissue lesion elsewhere in the body.
The present review aimed to systematically review skin toxicity changes following breast cancer radiotherapy (RT) using ultrasound (US). PubMed and Scopus databases were searched according to PRISMA guidelines. The characteristics of the selected studies, measured parameters, US skin findings, and their association with clinical assessments were extracted. Seventeen studies were included with a median sample size of 29 (range 11-166). There were significant US skin changes in the irradiated skin compared to the nonirradiated skin or baseline measurements. The most observed change is skin thickening secondary to radiation-induced oedema, except one study found skin thinning after pure postmastectomy RT. However, eight studies reported skin thickening predated RT attributed to axillary surgery. Four studies used US radiofrequency (RF) signals and found a decrease in the hypodermis's Pearson correlation coefficient (PCC). Three studies reported decreased dermal echogenicity and poor visibility of the dermis-subcutaneous fat boundary (statistically analysed by one report). The present review revealed significant ultrasonographic skin toxicity changes in the irradiated skin most commonly skin thickening. However, further studies with large cohorts, appropriate US protocol, and baseline evaluation are needed. Measuring other US skin parameters and statistically evaluating the degree of the association with clinical assessments are also encouraged.