External hemipelvectomy as treatment for solitary coxofemoral metastasis from endometrial carcinoma: Case report and review of the literature

Abstract

The best treatment for bone metastasis from endometrial cancer as a presenting feature is unclear. We report the first case in the literature of coxofemoral metastases from endometrial cancer treated by surgical approach. Then, after a careful review of the literature, we discuss the best therapeutic option for this subset of patients. A 62-year-old woman with pain, erythema and swelling of the left leg and no history of postmenopausal bleeding underwent biopsy of the leg, which revealed a moderately differentiated endometrial carcinoma, infiltrating muscle and adipose tissues. There were no other sites of distal spread. A literature review was conducted by searching the items 'endometrial cancer' and 'bone metastasis' in MEDLINE and EnBase up to September 2010. The patient was treated with neoadjuvant chemotherapy, but she did not show a clinical response. By considering her prognosis and quality of life, we decided to perform for the first time a total abdominal hysterectomy with bilateral salpingo-oophorectomy in addition to an external hemipelvectomy with a limb amputation and partial ilium and pubic preservation. Thirty months after the procedure the patient is still alive. No other similar results are present in the literature. Patients in good clinical condition with a single bone metastasis of endometrial cancer should be treated aggressively with surgery, as survival can be extended with an acceptable quality of life.

Dedifferentiated endometrioid adenocarcinoma: An under-recognized but aggressive tumor?

“…There were no reported cases of bony metastases, leave alone those that initially presented with pathologic fractures (Silva et al, 2006). Vizzelli et al (2012) most recently compiled cases of endometrial cancer presenting as bone metastases and noted the bones of the appendicular skeleton, such as the tibia, femur, calcaneus, and fibular and humerus, to be the most typical bony structure affected. Based on a PubMed search from 1950 to the present, using keywords including “endometrial neoplasms” and “bone neoplasms”, there have only been 4 prior cases of endometrial cancer presenting with spinal metastases, and none in combination with lytic lesions in the humerus, as seen in the current case.…”

Resectability and Vascular Management of Retroperitoneal Gynecological Malignancies: A Large Single-institution Case–Series

“…In recent years, the role of radical surgery aimed to remove pelvic and abdominal disease has been consolidated, both in primary and recurrent gynecological cancers (1)(2)(3)(4)(5)(6)(7)(8). Indeed, a certain percentage of gynecological tumor involves major retroperitoneal blood vessels, such as the inferior vena cava, aorta, iliac or visceral vessels, requiring planned vascular resection (9)(10)(11).…”

“…Radical surgery, which is a milestone in the treatment of these malignancies, may require tailoring the extension of the intervention to other non-gynecological structures (3)(4)(5)(6)(7)(8). Among them, one of the most important districts connected with major gynecological oncology surgery is the vascular one (9)(10)(11).…”

Can surgical management of bone metastases improve quality of life among women with gynecologic cancer?

“…The treatment of patients with bone metastases should be tailored to the individual patient and based on factors such as age, performance status, presence of simultaneous metastasis, and site of bone affected. The primary goal of surgical intervention is to eliminate or alleviate pain and preserve quality of life, with a possible prolongation of life [18]. There are few previous reports detailing both quality of life parameters and functional outcomes following surgical treatment for recurrent gynecological malignancies presenting as bone metastasis.…”