Malignant Soft Tissue Tumors of the Biceps Muscle Mistaken for Proximal Biceps Tendon Rupture
Abstract
Tears of the proximal long head of the biceps tendon are among the most common tendon tears in the body. In most cases, the diagnosis is easily determined based on the history and physical examination. However, malignant soft tissue tumors can simulate proximal biceps tendon tears. Although tumors simulating tears of the distal biceps tendon at the elbow have been reported, to the authors’ knowledge, no previous cases of tumors simulating or being mistaken for proximal biceps tendon tears have been reported.
This article describes 2 cases of malignant sarcomas initially mistaken for tears of the long head of the biceps tendon. In the first case, a 62-year-old woman developed swelling in her arm after feeling a twinge in her shoulder. A magnetic resonance imaging scan was misread as a biceps tendon tear and not treated by the examining physician. In the second case, a mass appeared with little trauma in the brachium of a 70-year-old man. On physical examination, the mass was hard to palpation. In each case, biopsy revealed a soft tissue sarcoma. Both patients underwent wide excision with radiation and are currently disease free. These 2 cases emphasize the importance of obtaining a good history and of performing a thorough shoulder and arm examination in patients with deformities consistent with tears of the long head of the biceps tendon.
- 1.Kransdorf MJ. Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location. AJR Am J Roentgenol. 1995; (164):129–134. Crossref Medline, Google Scholar
- 2.McFarland EG. Examination of the biceps tendon and superior labrum anterior and posterior (SLAP) lesions. In: , eds. Examination of the Shoulder: The Complete Guide. New York, NY: Thieme; 2006:213–243. Google Scholar
- 3.Mizuno S, Ikegami H, Nakamura T, Complete rupture through the short head of the biceps muscle belly: a case report. J Shoulder Elbow Surg. 2011; 20(7):e14–e17.
10.1016/j.jse.2011.04.026 Crossref Medline, Google Scholar - 4.Bradshaw AR, Sandow MJ, Clayer MT. Distal biceps tendon partial tear presenting as a pseudotumor. J Shoulder Elbow Surg. 2011; 20(1):e14–e17.
10.1016/j.jse.2010.08.011 Crossref Medline, Google Scholar - 5.Weiss SW. Malignant fibrous histiocytoma. A reaffirmation. Am J Surg Pathol. 1982; 6(8):773–784.
10.1097/00000478-198212000-00009 Crossref Medline, Google Scholar - 6.Nove-Josserand L, Walch G. Long biceps tendon. In: , eds. Shoulder Surgery: An Illustrated Textbook. London, UK: Martin Dunitz; 2001:243–259. Google Scholar
- 7.Rohrich RJ, Rich BK. Intramuscular ganglion of the biceps muscle. Ann Plast Surg. 1994; 33(4):432–433.
10.1097/00000637-199410000-00014 Crossref Medline, Google Scholar - 8.Combalia A, Sastre S, Casas F. Lung carcinoma with metastasis to biceps muscle: report of a case and review of literature. Eur J Orthop Surg Traumatol. 2004; 14(3):172–176.
10.1007/s00590-004-0148-z Crossref Medline, Google Scholar - 9.Chandler RW, Shulman I, Moore TM. Renal cell carcinoma presenting as a skeletal muscle mass: a case report. Clin Orthop Relat Res. 1979; (145):227–229. Medline, Google Scholar
- 10.Ates M, Karakaplan M. Hydatid cyst in the biceps and gluteus muscles: case report. Surg Infect (Larchmt). 2007; 8(4):475–478.
10.1089/sur.2006.040 Crossref Medline, Google Scholar - 11.Akosa AB, Ali MH. Extramedullary plasmacytoma of skeletal muscle. A case report with immunocytochemistry and ultrastructural study. Cancer. 1989; 64(7):1504–1507.
10.1002/1097-0142(19891001)64:7<1504::AID-CNCR2820640724>3.0.CO;2-9 Crossref Medline, Google Scholar - 12.Tori M, Akamatsu H, Mizutani S, Multiple benign metastasizing leiomyomas in the pelvic lymph nodes and biceps muscle: report of a case. Surg Today. 2008; 38(5):432–435.
10.1007/s00595-007-3609-2 Crossref Medline, Google Scholar - 13.Gaeta M, Mazziotti S, Minutoli F, MR imaging findings of focal myositis: a pseudotumour that may mimic muscle neoplasm. Skeletal Radiol. 2009; 38(6):571–578.
10.1007/s00256-009-0664-3 Crossref Medline, Google Scholar - 14.Tohme-Noun C, Le Breton C, Sobotka A, Imaging findings in three cases of the nodular type of muscular sarcoidosis. AJR Am J Roentgenol. 2004; 183(4):995–999. Crossref Medline, Google Scholar
- 15.Abdelwahab IF, Klein MJ, Hermann G, Abdul-Quader M. Solitary cysticercosis of the biceps brachii in a vegetarian: a rare and unusual pseudotumor. Skeletal Radiol. 2003; 32(7):424–428.
10.1007/s00256-003-0638-9 Crossref Medline, Google Scholar - 16.Sim FH, Frassica FJ, Frassica DA. Soft-tissue tumors: diagnosis, evaluation, and management. J Am Acad Orthop Surg. 1994; 2(4):202–211. Crossref Medline, Google Scholar
- 17.Weisstein JS, Conrad EU. Tumors and related conditions. In: , eds. The Shoulder. 4th ed. Philadelphia, PA: Saunders; 2009:1509–1556. Google Scholar
- 18.Burkhead WZ, Habermeyer P, Walch G, Lin K. The biceps tendon. In: , eds. The Shoulder. 4th ed. Philadelphia, PA: Saunders; 2009:1309–1360. Google Scholar
- 19.Ma LD, McCarthy EF, Bluemke DA, Frassica FJ. Differentiation of benign from malignant musculoskeletal lesions using MR imaging: pitfalls in MR evaluation of lesions with a cystic appearance. AJR Am J Roentgenol. 1998; 170(5):1251–1258. Crossref Medline, Google Scholar
- 20.Fayad LM, Wang X, Salibi N, A feasibility study of quantitative molecular characterization of musculoskeletal lesions by proton MR spectroscopy at 3 T. AJR Am J Roentgenol. 2010; 195(1):W69–W75.
10.2214/AJR.09.3718 Crossref Medline, Google Scholar
