Femoral metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

Left hip pain.

Patient Data

Age: 65 years
Gender: Male
X-ray

X-ray femur

There is erosion and lysis of the medial cortex of the proximal femoral shaft over an area of approximately 5 cm.

CT

CT femur

An aggressive medularly mass with cortical lysis of the medial aspect of the proximal femoral shaft is noted with a small extraosseous component.

X-ray

Chest x-ray

There is a rounded mass at the upper part of the right hilum measuring approximately 4 cm.
No other lung nodules or masses are seen.
Minor atelectasis in the right upper lobe.
Cardiomediastinum normal.

CT

CT chest

A right upper lobe spiculated soft tissue lung mass measures approximately 5.5 cm x 4.5 cm x 4 cm ( AP, trans, long ). This severely narrows the right upper lobe main bronchus and also surrounds and narrows the right upper lobe main pulmonary artery. There is associated collapse of the posterior segment of the right upper lobe. There is a tiny right pleural effusion. There is mild centrilobular emphysema in the left upper lobe with more severe change on the right. There is a 6 mm nodule in the apical segment of the right lower lobe. There is no left pulmonary nodule or mass.

There is mediastinal lymphadenopathy. The large right mid paratracheal node measures 2.5 cm. A right hilar lymph node measures 20 mm.

Case Discussion

The patient also had a posterior fossa metasisis (how they presented) which was resected.

Histology

Immunohistochemistry shows strong nuclear staining in tumour cells for TTF-1 and strong cytoplasmic staining for cytokeratins CK7 and BerEp4. There is also strong staining for CEA. No taining for cytokeratin CK20 is seen in tumour cells. This profile confirms an origin of tumour from lung.

FINAL DIAGNOSIS: Posterior fossa tumour: Metastatic moderately differentiated adenocarcinoma with features consistent with an origin from lung.

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Case information

rID: 23325
Case created: 6th Jun 2013
Last edited: 6th Mar 2016
Inclusion in quiz mode: Included

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