April 21st, 2018

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Title:
Lytic Bone Lesion in Endometrial Carcinoma: A Case Report
Authors:  J. Stuart May, M.D., Felix Cheung, M.D., and Nadim Bou Zgheib, M.D.
 
BACKGROUND: Endometrial cancer is the most common gynecologic malignancy and the fourth most common of all malignancies in women. The usual presenting symptom is postmenopausal bleeding. Most cases are stage I or II when diagnosed. Osseous metastasis is rare (0–2% of cases) and is known to be a poor prognostic indicator.

CASE: We report a case of endometrial cancer with an isolated lytic boney lesion detected on plain radiograph as initial workup for leg pain. Extensive workup determined that the bone lesion was actually negative for metastasis. Although there was great suspicion of osseous metastasis based on plain radiographs, we thought it was too superficial to base important treatment decisions solely on this finding. A bone scan and a PET scan also indicated likely metastatic disease. A CT-guided core needle biopsy by interventional radiology was negative for metastasis. Unsatisfied with this result, Orthopedic Oncology opted for open biopsy. Two biopsies returned negative for metastasis on frozen section. Finally, after this thorough investigative workup excluded osseous metastasis, treatment was recommended.

CONCLUSION: Diligent diagnostic testing prevented unwarranted additional radiation therapy and all of its undesirable side effects. This report emphasizes the need for thorough diagnostic workup of lytic boney lesions in endometrial cancer beyond plain radiographs to properly determine treatment regimens.
Keywords:  diagnosis, endometrial cancer, endometrial carcinoma, lytic bone lesion, lytic lesion
   
   
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