Presentation
History of right hip pain for several months. Worsening pain with difficulty ambulating.
Patient Data
There is a large soft tissue lesion in the right pelvis. The lesion causes extensive destruction of the right iliac bone, acetabulum and the sacrum. Along the inferior aspect of the lesion, there is a rim-enhancing collection.
Case Discussion
This is a case of an occult squamous cell carcinoma.
As stated in the clinical history, the patient had right hip pain for 6-8 months that progressively worsened. Given the severity of the pain, the patient required crutches for ambulation. MRI of the pelvis and right hip only demonstrated mild degenerative changes. Approximately 5-6 months later, the above CT findings were found, indicating rapid tumor growth.
The patient underwent CT guided biopsy which revealed cells with strong positive reactivity to CK5/6 and p40, consistent with squamous differentiation. The Ki-67 was high, indicating high proliferative activity. The initial consideration was metastatic cervical carcinoma. However, the patient routinely received pap smears (negative). The cervix was endoscopically evaluated, and curettage and multiple biopsies were obtained, all of which were negative. E6/E7 mRNA was not detected. Additionally, the patient had no history of ovarian pathology and her ovaries were radiographically normal.
The patient was followed for several months with surveillance imaging, including CT of the chest, abdomen, and pelvis and whole body PET/CT to evaluate for metastatic disease. Besides the observed malignancy, there were no other areas demonstrating high radiotracer uptake.
The patient treated with chemotherapy and external beam radiotherapy.
Co-author:
Michael Cooley, MD
Christine Cooley, MD
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