Management of Rare Case of Solitary Metastasis Shaft of Humerus with Pathological Fracture with Intercalary Resection and Nail Cement Implantation: A Case Report

Abstract

with an Osteolytic Lesion around the fracture site (Fig. 1 and 2). There was significant osteoporosis over the entire humerus. Oncologist was consulted then, he suggested MRI of Full length humerus with blood investigations including markers for multiple myeloma. General surgeon, gastroenterologists, and pulmonologist consultations were made to rule out any tumor and to look for primary lesion. MRI–suggested hypo dense lesion T1 at the diaphysis region with soft tissue extension–mostly suggestive of Metastasis, Lymphoma, Osteosarcoma. After these consultations, patient was investigated with PET scan, USG thyroid, CT-chest, CT-abdomen and pelvis, stool occult blood to look for signs of primary lesion and metastatic lesions. CECT–chest suggested? Squamous cell carcinoma in right lower quadrant. Bronchoalveolar lavage and biopsy did which showed EGFR TKI positive tumor. So patient has been started on Erlotinib, Afatinib as 1st line chemotherapy drugs and maintenance therapy for 4–6 cycles for tumour bulk reduction and as a palliative therapy. CECT abdomen was normal and there were no lesions in breast, prostate, thyroid, and adrenals. In t r o d u c t I o n