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Lung Cancer |

Patellar Metastasis as the First Manifestation of an Adenocarcinoma of the Lung FREE TO VIEW

Marta Sousa, MD; Vitor Melo, MD; Eloisa Silva, MD; Jorge Vale, MD; João Silva, MD; Bárbara Rodrigues, MD; António Torres, MD
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Centro Hospitalar Tondela-Viseu, Viseu, Portugal


Chest. 2014;145(3_MeetingAbstracts):316A. doi:10.1378/chest.1836493
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Abstract

SESSION TITLE: Cancer Case Report Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Bone is the third most common site for metastatic disease. However, the patella, for its poor vascular supply, is a rare place for metastasis, with only a few reports in the literature, mainly from breast and lung tumors.

CASE PRESENTATION: A 60 year-old male, former smoker (48 pack-years), with a history of a recent upper gastrointestinal bleeding episode, resulting from multiple use of anti-inflammatory drugs, was admitted to the emergency room for a 2 month course of left knee pain, with a progressive worsening and with no relief with analgesic drugs, and weight loss. He denied respiratory symptoms or from other system. At physical examination we observed inflammatory signs in the left knee. The patient performed an x-ray of the left knee, which was normal, and a CT of the same region, which showed an osteolytic lesion of the patella. This lesion was biopsied and the histology revealed a metastasis of an adenocarcinoma. The CT of the chest and abdomen showed three lung nodules, with spiculated borders - two in the left upper lobe (LUL), with 20 and 32 mm, and one of 12 mm in the right upper lobe, suggestive of metastatic lesions - and the upper gastrointestinal endoscopy revealed an erosion in the lesser curvature of the stomach, whose biopsy confirmed an inflammatory gastropathy. The diagnosis was established by transthoracic biopsy, of the pulmonary nodule in the LUL, which revealed an adenocarcinoma of the lung. The PET-CT showed an hypercaptation of the pulmonary lesions, of a conglomerate lymph node mass in the hilum and of the patellar lesion, suggestive of active metastatic disease. The patient was referred to Oncology and submitted to quimiotherapy and radiation of the left knee. Eight months after the diagnosis, he was admitted to the emergency room for a cranioencephalic traumatism, the CT revealed multiple brain metastasis and he initiated radiation therapy. Ten months after the diagnosis he died from disease progression.

DISCUSSION: The authors highlight the lack of respiratory symptoms and this rare presentation of a lung cancer, with only six similar publications of pulmonary adenocarcinomas with patellar metastasis.

CONCLUSIONS: Despite of being rare, distant neoplasms should be in the differential diagnosis of a common orthopedic symptom, as anterior knee pain.

Reference #1: Wu B, Xiu Y, Jiang L, Shi H.; SPECT/CT imaging of patella metastasis from a squamous carcinoma of the lung; Clin Nucl Med. 2013 Feb; 38(2):125-7

DISCLOSURE: The following authors have nothing to disclose: Marta Sousa, Vitor Melo, Eloisa Silva, Jorge Vale, João Silva, Bárbara Rodrigues, António Torres

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