Acrometástasis en astrágalo de adenocarcinoma endometrioide

Introduction

The term acrometastasis is given to those metastases distal to the elbows and knees. They are rare and account for only 0.1% of all metastatic bone lesions. Endometrioid adenocarcinoma (EA) is the most frequent in the female genital tract cancer in developed countries. Bone metastases are rare in EA.

Case report

A 57 year old female 57 years presenting with trans-vaginal bleeding (TVB). The ultrasound and endometrial biopsy reported a moderately differentiated AE. This was initially treated with a hysterectomy, bilateral pelvic and para-aortic lymphadenectomy plus 50.4 Gy external radiotherapy, and intracavitary brachytherapy. Six months later she complained of pain in left ankle and inability to walk. Computed tomography showed an expansive lytic lesion, predominantly in the talus. As the bone biopsy reported a moderately differentiated metastatic endometrioid adenocarcinoma, treatment is initiated with radiotherapy of 30 Gy. Support was deferred and palliative chemotherapy started with paclitaxel and carboplatin in six cycles, as well as monthly application of zoledronic acid. Currently, after twelve months follow-up the patient has made good progress, with pain in left ankle, and tolerating walking.

Conclusion

The treatment strategy in patients with isolated acrometastasis remains controversial, and there are few cases described in the literature. External radiotherapy is usually considered as treatment of choice for these lesions. Acrometastasis is rare but should be taken into account in patients with cancer, who have unexplained severe pain in hands and feet.