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Direct bony invasion of malignant melanoma
Abstract and Figures
Malignant melanoma is known to spread by local extention, by the lymphatics by the blood stream. Direct invasion of the bone from a cutaneous melanoma is unknown. Hence, this case is presented in view of its rarity. A 75-year-old Caucasian lady presented with a small papillary lesion in the region of a recurrent chronic cellulitis on the lower third of the lateral aspect of the right leg. Histopathology diagnosed the lesion as locally advanced malignant melanoma. Radiological investigations by X-ray and magnetic resonance imaging revealed malignant infiltration of the tibia in its mid and lower third with two soft tissue metastatic masses adjacent. Histology following amputation confirmed malignant melanoma with cranial resection margin involvement. She underwent a further above-knee amputation followed by chemotherapy. The patient recovered from the amputation but subsequently died 6 months later due to bronchopneumonia from lung metastasis.
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... 1,2 Metastasis from malignant melanoma (MM) is known to spread by local extension, by the lymphatics, or by the bloodstream. 3 Most commonly appearing on the skin, followed by the meninges, eyes, mucosae, anorectal region, and the bone 4 , melanoma occurs with the same incidence in men as in women, especially ones who have experienced frequent exposure to sunlight. 2 Among men, melanoma most often appears on the upper back, whereas women most often experience it on the lower legs. ...
Introduction and importance: Occurring in only 1% of cases of anorectal malignancy, malignant melanoma generally appears in the fifth and sixth decades of life, with complaints of anorectal bleeding or pain. The prognosis is generally poor. Although anorectal melanoma currently lacks a recommended treatment, surgery alone remains the primary modality treatment, the role of adjuvant therapy is generally minimal, and survival rate improves with early diagnosis. Presentation of case : Here, we report two cases of a rare malignant melanoma in the rectum treated with abdominoperineal resection and local excision. The first case is a 60-year-old man with a history of defecating bloody stool and the appearance of a lump on the anal opening. The abdominoperineal resection was performed followed by adjuvant chemoradiotherapy. The second case is a 51-year-old woman with a similar complaint and clinical finding with the first case. The second case was treated with a tumor excision procedure followed by adjuvant chemoradiotherapy. However, the lump was recurrence after 7 months of prior tumor excision. Discussion: Surgical resection of anorectal melanoma is debatable. While surgical resection is still the most common treatment option, there is no agreement on whether abdominoperineal resection or local excision is the best option. Conclusions: The abdominoperineal resection may offer a lower recurrence probability than that of tumor excision alone. However, further study is required to provide evidence-based surgical treatment
... Another typical finding of cutaneous melanomas is that the direct invasion of bone is exceedingly rare [25]. ...
Congenital and infantile malignant melanomas are rare and typically carry poor prognosis. The purpose of this article was to review the data on congenital and infantile malignant melanomas of the scalp in order to understand its presentation, diagnosis, management, and outcomes of congenital melanoma of scalp. We searched PubMed, CINAHL and Cochrane databases. Ten cases of congenital and 3 cases of infantile malignant melanoma of scalp were identified. The diagnosis was confirmed by biopsy and histological analysis for confirmation. The prognosis depends on the origin of disease (congenital melanocytic nevus, transplacental metastasis, or de-novo), tumor thickness, the presence of ulceration and/or necrosis, and anatomic site (scalp lesions having poor prognosis). The most commonly used treatment of the reported cases of congenital and infantile melanoma was surgical excision of the primary lesion. Further modes of treatment may be extrapolated from the treatment of childhood and adult melanomas.
... The first one develops slowly and usually does not produce metastases (2,3). The other ones develop rapidly, producing metastases to the neighbouring lymph nodes, and in the case of malignant melanoma also to he brain, bones or kidneys (4)(5)(6)(7). ...
The most common skin neoplasms are carcinoma: basocellulare, spinocellulare, planoepitheliale and melanoma malignum. Early surgical treatment is crucial for recovery as well as for good aesthetic result, especially on exposed body parts. All those lesions are visible for observers and the time from their appearance to surgical treatment seems to be too long. The aim of the study was to answer the following questions: 1. After what time from the skin lesion appearance the patients report to a surgeon? 2. What is the underlying cause of delayed reporting for treatment of patients with skin lesions?
Questionnaire studies and analysis of medical histories were performed in the group of patients referred to Plastic Surgery Out-Patient Clinic in Łódź because of facial skin tumor in the last 5 years. Finally we collected data for 123 patients.
The analyzed group consisted mostly of men (n=72). The age of respondents ranged from 45 to 92 years, mean 69.9 years ± 10.8 years. Mean time from observing lesion to the first medical consultation was 7.3 months and to visiting our Out-Patient Clinic was 2.7 years (ranged from 3 months to 16 years). All patients were qualified to surgical excision of tumor. Histopathological verification confirmed diagnosis of malignant neoplasms in 116 patients. In question concerning causes of delay in medical consultation or treatment, all respondents answered that fear of surgical procedure was one of the reasons.
Fear of surgical treatment is the most common cause of delay in patients' visiting doctor. In our society conviction of neoplasm spreading after surgical excision is common, especially among elderly.
A 9-year-old intact male Brazilian Mastiff dog with a 1-year history of progressive severe swelling in all four limbs and significant locomotory difficulty was euthanized due to unresponsiveness to medical management. Macroscopically, the distal phalanx of the 5th digit of the left hindlimb was replaced by a cutaneous, non-ulcerated, 3.0 cm diameter, multilobulated, black, firm nodule. The cortical bones of the appendicular skeleton were thickened and partially effaced by infiltrative coalescing nodules (0.1–1.0 cm diameter). The lungs, heart, pleura, mesentery, adrenal glands and kidneys were infiltrated by similar nodules (0.5–3.5 cm diameter). Histological evaluation of the masses revealed a non-encapsulated malignant neoplasm composed of spindloid to polygonal cells that contained variable amounts of intracytoplasmic melanin and were arranged in haphazardly interlacing streams and bundles supported by scant fibrovascular stroma with myxoid and chondroid matrix formation. Neoplastic cells had intense cytoplasmic labeling for S100 and 10% had moderate cytoplasmic immunoreactivity for Melan-A. To the authors’ knowledge, this is the first description of a canine metastatic digital chondrogenic melanocytic tumour with strongly suggestive chondroid differentiation of neoplastic melanocytes.
Introduction. Melanoma is a malignant neoplasm of melanocytic origin. The risk of melanoma among the white race in Europe and USA is from 1/100 000 to 1/200 000. Objective. To present a case with multiple melanoma metastases to the skin of the thorax and abdomen with an atypical clinical picture mimicking herpes zoster infection. Case report. Male patient 77 years old. The primary lesion - a dark brown nodule, 2 cm in diameter - appeared half a year earlier. Under local anaesthesia, the nodule was removed with a 3 cm skin margin. Two months later, multiple, non-painful, brown nodules appeared on the left part of the chest and abdomen and were diagnosed as herpes zoster. The histopathological examination revealed melanoma metastases. Conclusions. We present a case of very fast appearance of malignant melanoma metastases, resembling herpes zoster infection. Although such a picture is rare, it is important to take this diagnosis into account in patients with "zoster" with no pain, resistant to antiviral treatment, and especially in patients with known melanoma history.
Although melanoma accounts for approximately 1% of all malignancies, melanoma metastases to the cerebellopontine angles (CPAs) are exceedingly rare. Here we describe a patient with melanoma metastases to the internal auditory canals and CPAs who presented with a remote history of cutaneous melanoma. This patient had a rapidly progressive hearing loss, vestibulopathy, and facial nerve dysfunction. Magnetic resonance imaging demonstrated bilateral, enhancing CPA lesions but was otherwise nonspecific. The diagnosis required a careful history, unilateral surgical resection for tissue acquisition, and histopathologic confirmation. A search for primary cutaneous melanoma at the time of presentation was negative. However, the history of cutaneous melanoma 8 years earlier distinguishes this patient's metastatic disease from solitary primary intracranial melanoma, an equally rare disease. Treatment consists of surgical excision, radiation, chemotherapy, and immunotherapy. The prognosis for patients with melanoma metastases is generally poor, but isolated reports of long-term survival have been described. Metastatic disease to the CPAs must be included in the differential diagnosis for any patient presenting with rapid-onset VIIth or VIIIth cranial nerve symptoms.
I love this book. I have a big, fat clothbound 1984 edition—there have been more since, but it is mine I love. I love everything about it, from its sheer weight to its extravagance. It was at the time the single most expensive thing I had ever bought. (I didn’t have a car.) I love the complete confidence it represented (it covered everything, without shame) and the beauty of studying a specialty in which a “short” practice manual had 1301 pages.It didn’t actually take me very long—I read it, cover to cover—to realise that it was old fashioned and in the main …
Marked nuclear atypia can be found in a variety of benign mesenchymal tumors, including ancient schwannomas, symplastic leiomyomas, osteoblastomas, and chondromyxoid fibromas. Such nuclear atypia is believed to represent a degenerative phenomenon and does not indicate aggressive behavior. Separation of these pleomorphic but benign lesions from true sarcomas may be difficult. We are aware of only one prior description of such degenerative atypia in benign giant cell tumor of bone. We report a benign giant cell tumor of bone arising in the sacrum of a 21-year-old white female. Preoperative embolization of this lesion had been performed, and subsequent curetting revealed marked atypia suggestive of an anaplastic malignancy. However, only very rare mitotic figures were present, and the radiographs were consistent with a benign giant cell tumor. A diagnosis of benign giant cell tumor was made, and no recurrence or metastases have been observed during the 4-year postoperative period.
Gastrointestinal (GI) metastasis from melanoma has a dismal prognosis with few long-term survivors. We evaluated the role of operative intervention for melanoma metastases to the GI tract and attempted to identify prognostic factors to improve selection of patients for surgery.
Between 1977 and 1997, 68 of the 7965 patients with melanoma admitted to Memorial Sloan-Kettering Cancer Center underwent surgical exploration for melanoma metastatic to the GI tract. Characteristics of the primary tumor, regional lymph nodes, and metastatic pattern were reviewed. Data concerning the presenting signs and symptoms, laboratory values, operative findings, extent of surgical resection, recurrence pattern, and survival were analyzed.
The most common presenting clinical features included anemia (n = 41; 60%) or abdominal pain (n = 40; 59%). The most frequently involved portion of the GI tract was the small bowel (n = 62; 91%), and the most common operative procedure was small bowel resection (n = 54; 79%). Postoperative mortality and morbidity were 2.9% (n = 2) and 8.8% (n = 6), respectively. Presenting symptoms were relieved in 90% of patients (n = 61). Median survival for all 68 patients following operative intervention was 8.2 months, with 18% survival at 5 years. By multivariate analysis, complete resection rendering the patient free of all identifiable disease (n = 19, median survival 14.9 months, 38% survival at 5 years) and a low preoperative serum lactate dehydrogenase (LDH) (n = 28, median survival 13.6 months, 35% survival at 5 years) were identified as independent favorable prognostic factors for survival.
Operative intervention for melanoma metastatic to the GI tract is recommended for palliative reasons and can be performed with low morbidity and mortality. It is associated with prolonged survival in patients rendered free of all identifiable disease following surgical resection and in those with a low preoperative serum LDH.
Neurilemmomas are benign tumors that arise from Schwann cells. They are rarely found on bone. We describe a neurilemmoma in a 45-year-old patient that affected the distal metaphysis of the radius. Only 1 previous case has been described in the literature. We discuss the clinical presentation, the radiographic aspect, particularly the magnetic resonance imaging characteristics, and the microscopic findings. (J Hand Surg 2000;25A:365–369. Copyright © 2000 by the American Society for Surgery of the Hand.)
Plasma cell tumours of the mastoid are rare malignancies of haematological origin. Two patients are described with a plasma cell tumour in the mastoid bone. In one patient it concerned a solitary plasmacytoma of the bone and in the other a focus in the mastoid of a recently diagnosed multiple myeloma. Symptoms in these patients were non-specific. Computed tomography (CT) and magnetic resonance image (MRI) scanning showed a non-specific space-occupying lesion in the mastoid. The diagnosis was made on immunohistological examination, that showed diffuse sheets of monoclonal plasma cells in a clear matrix. When a plasmacytoma lesion is found multiple myeloma should always be excluded. Treatment in case of solitary plasmacytoma of the mastoid bone consists of radiotherapy. In case of localization in the mastoid of multiple myeloma the treatment consists of palliative chemotherapy.
Malignant melanomas are relatively unusual tumors in the parotid gland. The majority of previously reported cases appear to represent metastatic lesions, often from cutaneous head and neck primaries.
Retrospective clinicopathologic review of 12 cases of malignant melanoma involving the parotid gland encountered between 1980 and October 1999 at a tertiary referral center.
Patients consisted of 9 men and 3 women ranging in age from 30 to 84 years (median, 66 years). Eleven of 12 patients presented with a neck mass or nodule. In 9 of 12 patients, a cutaneous or conjunctival primary was noted in the head region. In 2 patients, a cutaneous melanoma and the parotid gland melanoma were diagnosed at the same time. In 1 patient, melanoma was initially diagnosed in the parotid gland, and a definite primary was not uncovered. All patients underwent excision of the parotid melanoma, which was accompanied by a lymph node biopsy or dissection in 10 out of 11 patients. Four patients received adjuvant radiotherapy, and 3 patients received adjuvant chemotherapy. Four of 11 patients had ipsilateral cervical lymph node metastasis at the time of parotid tumor resection, and 5 patients had involvement of intraparotid lymph nodes by metastatic melanoma. Tumors ranged in size from 0.3 to 2.5 cm in greatest dimension. Multiple parotid nodules were noted in 4 patients. All tumors were characterized by a diffuse proliferation of cells with abundant eosinophilic cytoplasm and prominent nucleoli. Four tumors demonstrated focal spindle cell regions. Intravascular and/or lymphatic involvement by tumor within the parotid gland was noted in 3 lesions. At last known follow-up, 6 patients had died with tumor at a median follow-up period of 11 months after parotid gland surgery. Four patients were alive with evidence of tumor at follow-up intervals of 4, 17, 21, and 113 months after parotid gland surgery. Two patients were alive with no evidence of residual tumor at 20 and 148 months of follow-up.
The majority of melanomas involving the parotid gland appeared to be associated with lymph node metastasis in and around the gland from a cutaneous primary in the head region. Prognosis is generally poor, although rare patients may survive a long period of time following surgery.
Acrometastases are a rare but important clinical entity. We present the case of a 54-year-old man with a metastasis to a digit from a primary thymic carcinoma. The prognostic implications of such a diagnosis are discussed.
Background and aims: Intraosseous lipoma of the calcaneus is thought to be a rare tumour. As most of the articles have been single case reports, we performed a meta-analysis to evaluate diagnostic and therapeutic procedures. Methods: Based on 54 cases located at the calcaneus, typical features and treatment were studied. Results: A predilection was seen for adults between 30 and 60 years of age. Males were affected in two of three cases. The lesions were found incidentally in 33%. Symptomatic cases presented with pain, and some patients showed additional tenderness or swelling. All calcaneal lipomas were located at the base of the neck of the calcaneus (Ward's triangle). Radiological appearance depends on the stage due to evolutionary changes of the tumour. Diagnosis can be established with CT or MRI, as both methods show fat-equivalent densities in the lesion. Pathological fracture has not been reported. Conclusion: Continued observation in asymptomatic cases is a reasonable clinical approach. We propose surgical treatment with curettage and bone grafting only in symptomatic cases.
Clear-cell sarcoma is a very rare tumor that is intimately associated with tendons or aponeuroses. It shares phenotypic features with malignant melanoma and is therefore also referred to as melanoma of the soft parts1. Women are affected more commonly than men. Patients usually are between twenty and forty years of age. Typical sites of the tumor are the limbs, especially the region of the foot and ankle2. Clear‐cell sarcoma is a highly malignant tumor. Metastases to the bones of the hand are very rare, accounting for 0.1% of all metastases3. To our knowledge, the capitate has not been previously reported as the initial metastatic site of soft-tissue sarcoma. Radical excision or even amputation is required for the treatment of such metastases.
A twenty‐nine-year‐old man presented with a four‐week history of pain in the right foot. On physical examination, the plantar surface of the foot was swollen and tender. Magnetic resonance imaging showed a well‐defined, ellipsoid mass measuring 8 4 3.8 cm, situated between the metatarsal bones and the plantar aponeurosis (Fig. 1). Computed tomography scans revealed erosion of the fifth metatarsal. Open biopsy was performed, and a circumscribed, lobulated nodular mass was found. Histological examination revealed a uniform pattern consisting of compact nests of rounded or fusiform cells with a pale or clear cytoplasm. In between the cells, a network of collagenous tissue was encountered (Fig. 2). Immunohistochemically, the tumor cells expressed antigens for S‐100 protein and melanoma-associated antigen, reflecting melanin synthesis. Antibodies reactive to epithelial membrane antigen and cytokeratin were negative. On the basis of these criteria, the diagnosis of clear‐cell sarcoma was made.
Fig. 1:
T1-weighted magnetic resonance image of the right foot, showing a plantar tumor with cystic areas resembling necrotic zones in the center.
Fig. 2:
a: Clear-cell sarcoma with compact nests of pale-staining …
Malignant melanoma is the most common metastatic tumor of the gastrointestinal tract and can present with fairly non-specific symptoms. A 63-year old man with previous enucleation of the left eye for a malignant coroidian melanoma presented signs of intestinal subocclusion. Weight loss and a palpable mass deep on the paraumbilical left region were the significant physical signs. Because the state of the patient had worsened, the diagnosis was made by ultrasonography examination. Segmental intestinal resection with regional lymph node dissection was performed. Surgical resection can be performed safely as patients for whom all sites of disease are completely resected experience significant improvements in survival times, compared with patients who undergo an incomplete resection. For selected patients, surgical treatment of metastatic melanoma involving the gastrointestinal tract is appropriate therapy.
The purpose of this work was done to evaluate the value of including the brain in the field of view of a whole-body 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography (FDG-PET) study of patients referred for the evaluation of body malignancies.
A total of 1026 consecutive patients were included in this work. The primary diagnoses were the following: lung (n = 253), colorectal (n = 148), head and neck (n = 61), lymphoma (n = 249), melanoma (n = 84), and others (n = 231). Whole-body FDG images including the brain were acquired with a dedicated PET tomograph (GE advance, General Electronic Medical Systems, Milwaukee, WI) one hour after the intravenous administration of 10 mCi of FDG. Two experienced nuclear medicine physicians interpreted the images. Positive findings in the brain or the skull were correlated with other imaging studies and clinical follow-up.
Abnormal findings were detected in 3.9% (40/1026) of the patients. Among the 40 abnormal focal lesions, 29 patients had a known history of cerebral disease, cerebrovascular or metastatic disease in most patients. Of the 11 patients without a prior history of cerebral disease, four patients had increased focal FDG uptake suggestive of metastases. Among these, two were proven clinically, one was proven to be a skull base metastasis on MRI, and the other had negative clinical follow-up, but only of two months duration. The other seven patients had a decreased focal FDG uptake most consistent with infarct, one was proven clinically, and the other six had a negative clinical follow-up (mean of 6.3 months, range 1-10), but had multiple risk factors for cerebrovascular disease.
We conclude that FDG-PET screening for cerebral lesions in patients with body malignancy has little clinical impact. Unsuspected cerebral or skull metastases were detected in 0.4% (4/1026) of the patients.
Malignant melanoma can metastasize to almost any organ site. Optimal management requires sensitive radiographic evaluation of the entire body. The optimal management of patients with metastatic melanoma requires accurate assessment of extent of disease (EOD). The objective of this study was to evaluate the accuracy of fluorine-18 deoxyglucose (FDG) whole-body positron emission tomography (PET) in determination of EOD in patients with metastatic melanoma and its impact on surgical and medical management decisions. Forty-nine patients (30 men, 19 women; aged 25-83 years) with known or suspected metastatic melanoma underwent EOD evaluation using computerized tomography (CT) of the chest, abdomen, and pelvis, and magnetic resonance imaging (MRI) of the brain. After formulation of an initial treatment plan, the patients underwent FDG-PET imaging. The EOD determined by PET was compared with physical examination and conventional radiography findings. Fifty-one lesions were pathologically evaluated. The impact of PET on patient management was assessed based on the alterations made in the initial treatment plan after reevaluation of the patients using the information obtained by PET. The PET scan identified more metastatic sites in 27 of 49 (55%) of the patients who had undergone a complete set of imaging studies, including CT scans of the chest, abdomen, and pelvis, and MRI of the brain. In 6 of those 27 patients, PET detected disease outside the fields of CT and MRI. Fifty-one lesions were resected surgically. Of these, 44 were pathologically confirmed to be melanoma. All lesions larger than 1 cm (29 of 29) were positive on PET, whereas only 2 of 15 (13%) lesions smaller than 1 cm were detected by PET. The results of PET led treatment changes in 24 patients (49%). Eighteen of these changes (75%) were surgical. In 12 cases (67%), the planned operative procedure was cancelled, and in 6 cases (33%), an additional operation(s) was performed. In 6 of 24 (25%) patients, biochemotherapy, radiation therapy, or an experimental immunotherapy protocol was prompted by identification of new foci of disease. Compared with conventional imaging, FDG-PET provides more accurate assessment of EOD in patients with metastatic melanoma. Significant surgical and medical treatment alterations were made based on PET results.
We report a case of a primary malignant fibrous histiocytoma of the distal radius in a 46-year-old man. Treatment involved en bloc resection, reconstruction with a nonvascularized free fibular autograft, and wrist arthrodesis combined with adjuvant chemotherapy. At the 2-year follow-up evaluation the patient had a satisfactory outcome with complete radiographic union and no evidence of a local recurrence or metastasis. Resection combined with autogenous fibular grafting and adjuvant chemotherapy appears to be an acceptable method for treating malignant fibrous histiocytoma of the distal radius in this patient.
Hyalinizing clear cell carcinoma (HCCC) of the salivary gland is new disease only recognized in recent years. It is rare and the standard treatment is still under investigation. This is a report of a 42-year-old female with HCCC who presented with a painless submucosal hard palatal mass of three years duration. Wide excision of the tumour and the underlying palatal and maxillary bones was performed. Pathological examination revealed typical clear cells arranged in anastomosing trabeculae, cords, nests, or solid sheets with a hyalinizing stroma. These clear cells were positive for the periodic acid-Schiff (PAS) reaction but were negative for the mucin stain. Immunohistochemically, these neoplastic cells were positive for cytokeratin, but negative for actin. No recurrence nor distant metastasis was found during the eight-month follow-up period.
Epithelioid hemangioendothelioma (EH) of a hand bone is extremely rare. We describe a patient with a phalangeal EH. This was treated by resection of the entire middle phalanx with no recurrence within a 10-year postsurgical follow-up period. We recommend wide resection as the safest treatment for EH of the hand phalanx.
A 72-year-old male presented with a painful index finger 18 months after sigmoid colon resection for T2 N1 adenocarcinoma. A presumptive diagnosis of gout was made but directed therapy failed to alleviate symptoms. A bone scan was positive for the index finger only and plain films demonstrated a lytic lesion of the distal phalanx. The patient underwent ray amputation of the involved digit and shortly later resection of a solitary pulmonary nodule consistent with colonic metastasis. At 18-month follow-up from these surgeries, the patient was doing well, without evidence of recurrent disease.
Malignant melanoma has an aggressive biological behaviour and a high rate of cardiac involvement. As shown from post-mortem studies, metastases of melanoma can involve any organ and cardiac metastases are frequent. This report describes a case of widespread malignant melanoma in a patient with clinical presentation of complete atrioventricular (AV) block. Thorax CT and transthoracic echocardiography revealed a mass involving the conduction system. By VDD permanent pacing (atrial synchronous ventricular pacing), haemodynamic stability was maintained and the patient remains under follow-up receiving chemo-immunotherapy. In the retrospective analysis of the patient's records, we realized that the AV conduction delay had been progressing for at least 7 months. Cardiac metastasis of malignant melanoma is a common finding and can proceed in the absence of overt clinical manifestations. Therefore, the clinician should be alert to the development of cardiac signs and symptoms in a metastatic melanoma patient and should perform a detailed cardiac examination to exclude cardiac metastasis of the tumour.
Basal cell carcinoma (BCC) is the most common skin malignancy and is most prevalent on the head and neck region, although BCC can occur in other sites, including the lower limbs.
We report the case of an 85-year-old female patient who experienced recurrent BCCs in the lower limb with tibial invasion.
Treatment consisted of wide skin excision, tibial osteotomy, intraoperative cryotherapy, and coverage with an internal gastrocnemius muscle flap.
The computed tomographic scan showed local bone control of the BCC, with no recurrence, so we avoided limb amputation.
The reported case is uncommon because of the site, the extent of bone infiltration, and local treatment with cryotherapy.
Metastasis to a lower-extremity bone is an extremely rare event in patients with endometrial carcinoma. A 64-year-old woman presented with progressive right leg pain but no gynecologic complaints. A diagnostic workup revealed primary endometrial carcinosarcoma with an isolated tibial metastasis. Though the patient received only local irradiation to the tibial lesion, complete resolution of symptoms resulted. Six months after the radiotherapy, the intraabdominal disease progressed and the patient died. We note that tibial metastasis is one of the possible presenting symptoms in patients with endometrial malignant tumors. Irradiation can improve their quality of life and so may be effective in the management of symptomatic tibial metastasis.