An Unusual Solitary Metatarsal Metastasis from an Endometrioid Endometrial Adenocarcinoma.

BACKGROUND: Endometrial cancer is the fourth most common tumor in women. Abnormal uterine bleeding is the leading symptom in 90% of cases. The more frequent metastatic sites include lymph nodes, omentum, lungs, and liver. Bone metastasis has been reported to occur in 2-6% of all metastatic endometrial cancers, particularly in high surgical stage and grade, the most common involved site being the spine and hip. CASE REPORT: We report here the case of a 62-year-old white woman hospitalized for a painful swelling in the left foot, which appeared from January 2014, postmenopausal bleeding, and a progressive weight loss in the last year. An endometrioid, endometrial cancer was diagnosed by hysteroscopy, associated with a solitary bone metastasis of the left metatarsus, histologically confirmed by biopsy. The patient refused any surgical procedure. She received a single-fraction of 800 cGy radiotherapy to the left foot, leading to optimal analgesic control. Subsequently, systemic chemotherapy was started using a carboplatin/paclitaxel-containing regimen with IV zoledronic acid. This treatment is ongoing. CONCLUSIONS: There is no standard treatment for endometrial cancer bone metastasis. The prognosis of these patients is poor, with a median survival of about 12-17 months. The treatment is predominantly palliative and relies on several factors, including patient clinical conditions, site and number of bone metastases, and the presence of any additional visceral lesions. An aggressive multimodal treatment should be proposed to very select patients presenting better prognostic factors. In our case, a solitary fifth metatarsal bone metastasis, histologically proved, was shown as initial presentation of an EC. Endometrial cancer can present as initial bone diffusion, even in atypical locations such as acrometastasis and it should be considered when bone metastases are diagnosed.

A late, solitary brain metastasis of epithelial ovarian carcinoma.

BACKGROUND: Brain metastasis from epithelial ovarian cancer (EOC) is very rare with a reported incidence of less than 2%. It is usually associated with a poor prognosis that is related to several factors, the most important including: single vs multiple lesions, performance status, platinum-sensitive disease, tumor grade, extracranial disease, and multimodal approach treatment. At the time of diagnosis, an extracranial disease is found in over half of patients. The most common histology is the serous type. The median time from primary diagnosis to development of cerebral lesions is directly correlated to initial tumor grade and stage. Several therapeutic approaches can be proposed, including best supportive care +/- corticosteroids, surgery, radiotherapy and chemotherapy. A multimodal therapy approach may achieve an improved outcome and should therefore be utilized whenever applicable. CASE PRESENTATION: We present the case of a patient with a solitary brain metastasis which appeared 11 years after a locally advanced and aggressive EOC (FIGO stage III C) and which totally regressed after surgery and adjuvant chemotherapy. Clinically, she showed progressive headaches, decreased visual acuity, balance and memory disorders associated with a confusional state. Brain CT scan and MRI documented a solitary, necrotic lesion in the left central parietal region with an important cerebral surrounding edema and initial cranial herniation. No other extracranial metastases were observed at the PET scan. Laboratory tests were in the normal range and CA 125 was moderatly increased at 81 UI/ml. The patient underwent surgical removal of tumor lesion, post-surgical whole-brain radiotherapy (WBRT) and systemic chemotherapy with carboplatin alone for six cycles. At a follow-up of 13 months, she is alive, in good clinical condition and tumor progression free. CONCLUSION: The peculiarity of this case relies on the isolated brain relapse of a BRCA-1/BRCA-2 non-mutated EOC, which is uncommon and rare, and to the very long time, of 11 years, from diagnosis of primary cancer and development of brain metastasis. A multimodal, aggressive approach of this isolated brain metastasis led to a complete and prolonged tumor control.