Isolated Humeral Metastasis in Uterine Cervical Cancer: A Rare Entity
A 56-year old post-menopausal female, gravida 5, para 3, was admitted to our hospital, with a 3-month history of abnormal vaginal bleeding. She underwent colposcopy-guided biopsy and the diagnosis was moderately differentiated invasive squamous cell carcinoma of uterine cervix, mixed small and large cell non-keratinizing variants. Work-up assessments including chest X-ray, abdomino-pelvic ultrasound exam, and contrast-enhanced pelvic MRI were done. The primary tumor, measuring 130 mm in its largest diameter, was located in the cervix and invasion of myometrium and the parametrial region were also revealed; nevertheless, there was no evidence of distant metastasis or lymph node enlargement. According to the imaging findings, the stage of the tumor was estimated to be at least IIB (T2b, N0, M0) and the patient underwent combined radio-chemotherapy followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy, according to our hospital protocol. The pathology confirmed the above mentioned findings as well as tumoral involvement of left adenex; whereas, the right ovary was unremarkable. Rectosigmoid and bladder wall biopsies also showed metastatic involvement. In addition, peritoneal washing result for malignancy was positive. Thereby, the accurate stage of the disease was defined as IVA (T4, N0, M0).\nSeven months after the treatment, she developed left elbow pain. Physical exam revealed decreased range of motion accompanied by soft tissue swelling in left elbow. Thereafter, plain X-ray, MRI of left upper extremity, and whole body bone scan were performed. In plain radiograph [] a destructive lytic lesion with pathologic fracture was found in the distal humerus. In the MRI exam [] a soft tissue mass with T1 hypo-signal and T2 intermediate-signal intensities was seen surrounding the distal part of the left humerus associated with destruction of bone cortex. Isotopic bone scan [] showed isolated increased tracer concentration at the distal part of the left humerus whereas no evidence of skeletal metastasis was found elsewhere. The biopsy from the bone lesion was taken and pathological examination of resected specimen confirmed metastatic squamous cell carcinoma [].