Skip to main content

Primary bone metastasis as initial presentation of endometrial cancer (stage IVb)

Abstract

Introduction

Endometrial cancer is the most common malignancy among females in developed countries. Abnormal uterine bleeding is the leading symptom in approximately 90 % of cases. The incidence of stage IV disease is approximately 5–10 % with a 5-year overall survival of less than 10 %.

Materials and methods

A rare case presented with femoral pathological fracture and underlying endometrial cancer. We discuss the diagnosis, management and literature review for this extremely rare entity which can be present even in the absence of vaginal bleeding.

Results

Literature search revealed 28 cases with primary bone metastasis and all were symptomatic at the time of diagnosis. Eighty percent of them had tumour on the lower limb and the majority did not have vaginal bleeding. The predominant histopathological type was endometrioid (72.4 %) and grade 1–2 (59 %). Treatment had been individualised and 57 % of the cases underwent surgery with removal of uterus and adnexa and only three patients (10.7 %) received pelvic radiotherapy. Bone tumour was treated with radiotherapy in 80 % of the cases, alone (28 %), or combined with primary surgery (12 %) or chemotherapy (40 %). Overall, 54 % of patients received chemotherapy and 46 % received hormone therapy. The mean survival of patients who presented with single-bone metastasis was significantly better than those with multiple extrauterine metastatic sites: mean 85.7 months (SE: 9.2) versus 22.9 months (SE: 5.2), p < 0.003, CI 95 %. These two different survival patterns are more likely to reflect two different biological disease behaviours. Those with advanced local and widespread disease progress quicker, in contrast to those with a single-bone extrauterine metastatic site and local disease limited to the uterus, which continues to behave as early stage endometrial cancer.

Conclusions

Although extremely rare, endometrial cancer can present as initial bone pathology. Endometrial biopsy should be included in the patient’s workup when investigating for metastatic bone adenocarcinoma of unknown origin, even when gynaecological symptoms are lacking, as this rare presentation of stage IVb endometrial cancer appears to have good survival outcomes.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    PubMed  Article  Google Scholar 

  2. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I (2005) Endometrial cancer. Lancet 366:491–505

    PubMed  Article  Google Scholar 

  3. Bakkum-Gamez JN, Gonzalez-Bosquet J, Laack NN et al (2008) Current issues in the management of endometrial cancer. Mayo Clin Proc 83:97–113

    PubMed  Article  Google Scholar 

  4. Goff B, Goodman A, Muntz H et al (1994) Surgical stage IV endometrial carcinoma: a study of 47 cases. Gynecol Oncol 52:237–240

    PubMed  Article  CAS  Google Scholar 

  5. Abrams HL, Spiro R, Goldstein N (1950) Metastases in carcinoma: analysis of 1,000 autopsied cases. Cancer 3:74–85

    PubMed  Article  CAS  Google Scholar 

  6. Mariani A, Webb MJ, Keeney GL, Calori G, Podratz KC (2001) Hematogenous dissemination in corpus cancer. Gynecol Oncol 80(2):233–238

    PubMed  Article  CAS  Google Scholar 

  7. Abdul-Karim FW, Kida M, Wentz WB, Carter JR, Sorensen K, Macfee M et al (1990) Bone metastasis from gynecologic carcinoma: a clinicopathologic study. Gynecol Oncol 39:108–114

    PubMed  Article  CAS  Google Scholar 

  8. Sahinler I, Erkal H, Akyazici E, Atkovar G, Okkan S (2001) Endometrial carcinoma and an unusual presentation of bone metastasis: a case report. Gynecol Oncol 82(1):216–218

    PubMed  Article  CAS  Google Scholar 

  9. Albareda J, Herrera M, Lopez Salva A, Garcia Donas J, Gonzalez R (2008) Sacral metastasis in a patient with endometrial cancer: case report and review of the literature. Gynecol Oncol 111(3):583–588

    PubMed  Article  CAS  Google Scholar 

  10. Batson OV (1940) The function of vertebral veins and their role in the spread of metastasis. Ann Surg 112(1):138–149

    PubMed  Article  CAS  Google Scholar 

  11. Batson OV (1995) The function of the vertebral veins and their role in the spread of metastases. 1940. Clin Orthop Relat Res 312:4–9

    PubMed  Google Scholar 

  12. Lambrou NC, Gomez-Marin O, Mirhashemi R et al (2004) Optimal surgical cytoreduction in patients with stage III and IV endometrial carcinoma: a study of morbidity and survival. Gynecol Oncol 93:653–658

    PubMed  Article  Google Scholar 

  13. Kokka F, Brockbank E, Oram D, Gallagher C, Bryant A (2010) Hormonal therapy in advanced or recurrent endometrial cancer. Cochrane Database Syst Rev 8(12):CD007926. doi:10.1002/14651858.CD007926.pub2

    Google Scholar 

  14. Wong MH, Stockler MR, Pavlakis N (2012) Bisphosphonates and other bone agents for breast cancer. Cochrane Database Syst Rev 15(2):CD003474

    Google Scholar 

  15. Rose PG, Brunetto VL et al (2000) Anastrozole in advanced or recurrent endometrial carcinoma: a GOG phase II trial. Gynecol Oncol 78:212–216

    PubMed  Article  CAS  Google Scholar 

  16. Rouchy R, Besson J, Grosieux P, Barraya PL (1967) Osseous metastasis revealing endometrial cancer. Bull Fed Soc Gynecol Obstet Lang Fr 19(4):352–353

    PubMed  CAS  Google Scholar 

  17. Vanecko RM, See TY, Schmitz RL (1967) Metastasis to the fibula from endometrial carcinoma. Report of 2 cases. Obstet Gynecol 29:803–805

    PubMed  CAS  Google Scholar 

  18. Onuba O (1983) Pathological fracture of right tibia, an unusual presentation of endometrial carcinoma: a case report. Injury 14:541–545

    PubMed  Article  CAS  Google Scholar 

  19. Cooper JK, Wong FL, Swenerton KD (1994) Endometrial adenocarcinoma presenting as an isolated calcaneal metastasis. A rare entity with good prognosis. Cancer 73:2779–2781

    PubMed  Article  CAS  Google Scholar 

  20. Petru E, Malleier M, Lax S, Lahousen M, Ehall R, Pickel H, Winter R (1995) Solitary metastasis in the tarsus preceding the diagnosis of primary endometrial cancer: a case report. Eur J Gynaecol Oncol 16:387–391

    PubMed  CAS  Google Scholar 

  21. Malicky ES, Kostic KJ, Jacob JH, Allen WC (1997) Endometrial carcinoma presenting with an isolated osseous metastasis: a case report and review of the literature. Eur J Gynaecol Oncol 18:492–494

    PubMed  CAS  Google Scholar 

  22. Dosoretz DE, Orr JW, Salanius SA, Orr PF (1999) Mandibular metastasis in a patient with endometrial cancer. Gynecol Oncol 72:243–245

    PubMed  Article  CAS  Google Scholar 

  23. Manolitsas TP, Fowler JM, Gahbauer RA, Gupta N (2002) Pain in the foot: calcaneal metastasis as the presenting feature of endometrial cancer. Obstet Gynecol 100:1067–1069

    PubMed  Article  Google Scholar 

  24. Neto AG, Gupta D, Broaddus R, Malpica A (2002) Endometrial endometrioid adenocarcinoma in a premenopausal woman presenting with metastasis to bone: a case report and review of the literature. Int J Gynecol Pathol 21:281–284

    PubMed  Article  Google Scholar 

  25. Arnold J, Charters D, Perrin L (2003) Prolonged survival time following initial presentation with bony metastasis in stage IVb endometrial carcinoma. Aust N Z J Obstet Gynaecol 43(3):239–240

    PubMed  Article  Google Scholar 

  26. Uharcek P, Mlyncek M, Ravinger J (2006) Endometrial adenocarcinoma presenting with an osseous metastasis. Gynecol Obstet Invest 61(4):200–202

    PubMed  Article  Google Scholar 

  27. Giannakopoulos CK, Kyriakidou GK, Toufexi GE (2006) Bone metastasis as a presenting feature of endometrial adenocarcinoma: case report and literature review. Eur J Gynaecol Oncol 27:95–97

    PubMed  CAS  Google Scholar 

  28. Loizzi V, Cormio G, Cuccovillo A, Fattizzi N, Selvaggi L (2006) Two cases of endometrial cancer diagnosis associated with bone metastasis. Gynecol Obstet Invest 61:49–52

    PubMed  Article  Google Scholar 

  29. Kaya A, Olmezoglu A, Eren CS, Bayol U, Altay T, Karapinar L, Ozturk H, Oztekin D, Guvenli Y, Karadogan I (2007) Solitary bone metastasis in the tibia as a presenting sign of endometrial adenocarcinoma: a case report and the review of the literature. Clin Exp Metastasis 24(2):87–92

    PubMed  Article  Google Scholar 

  30. Farooq MU, Chang HT (2008) Intracranial and scalp metastasis of endometrial carcinoma. Med Sci Monit 14(9):CS87–CS88

    PubMed  Google Scholar 

  31. Shigemitsu A, Furukawa N, Koike N, Kobayashi H (2010) Endometrial cancer diagnosed by the presence of bone metastasis and treated with zoledronic acid: a case report and review of the literature. Case Rep Oncol 3(3):471–476

    PubMed  Article  Google Scholar 

  32. Kehoe SM, Zivanovic O, Ferguson SE, Barakat RR, Soslow RA (2010) Clinicopathologic features of bone metastases and outcomes in patients with primary endometrial cancer. Gynecol Oncol 117(2):229–233

    PubMed  Article  Google Scholar 

  33. Artioli G, Cassaro M, Pedrini L, Borgato L, Corti L, Cappetta A, Lombardi G, Nicoletto MO (2010) Rare presentation of endometrial carcinoma with singular bone metastasis. Eur J Cancer Care (Engl) 19(5):694–698

    Article  CAS  Google Scholar 

  34. Jiang GQ, Gao YN, Gao M, Zheng H, Yan X, Wang W, An N, Cao K (2011) Clinicopathological features and treatment of extremity bone metastasis in patients with endometrial carcinoma: a case report and review. Chin Med J (Engl) 124(4):622–626

    Google Scholar 

  35. Gottwald L, Dukowicz A, Piekarski J, Pasz-Walczak G, Spych M, Kazmierczak-Lukaszewicz S, Cialkowska-Rysz A (2012) Isolated metastasis to the foot as an extremely rare presenting feature of primary endometrial cancer. Arch Med Sci 8(1):172–174

    PubMed  Article  Google Scholar 

  36. Uccella S, Morris JM, Bakkum-Gamez JN, Keeney GL, Podratz KC, Mariani A (2013) Bone metastases in endometrial cancer: report on 19 patients and review of the medical literature. Gynecol Oncol. doi:10.1016/j.ygyno.2013.05.010

Download references

Conflict of interest

Authors declare no conflict of interest. They have had full control of all primary data and agree to allow the journal to review their data if requested.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eva Myriokefalitaki.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Myriokefalitaki, E., D’Costa, D., Smith, M. et al. Primary bone metastasis as initial presentation of endometrial cancer (stage IVb). Arch Gynecol Obstet 288, 739–746 (2013). https://doi.org/10.1007/s00404-013-2956-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-013-2956-z

Keywords

  • Primary bone metastasis
  • Endometrial cancer
  • Fracture
  • Stage IV
  • Initial presentation
  • Survival