Presentation
Acute and sudden hip pain after fall due to accidentally tripping on the carpet.
Patient Data
Diffuse metastatic disease in the pelvis and left proximal femur, associated with multiple bilateral pathological fractures. Notice that the fracture ranges from left acetabulum to left pectineal and arcuate lines, in addition to transverse fracture of the homolateral femoral metadaphysis.
Osteolytic and osteoblastic lesions diffusely distributed in the pelvis and left femur, besides important fracture of posterior aspect of right acetabulum and extensive fracture of left pectineal and arcuate lines.
Case Discussion
The patient presented above was diagnosed with invasive ductal carcinoma (IDC) in the right breast in 2003. First signs of bone metastasis to the pelvis and left femur were found on 2009. Multiple therapies were attempted since then, including radical mastectomy, radiotherapy, chemotherapy, hormone and immunotherapy. Unfortunately, the treatment attempts had a minimum effect and eventually, the patients' bone metastases became resistant to almost every therapy, which is usually expected in this scenarios1, and finally evolving to the event previously described.
A pathologic fracture is a common event in patients with bone metastasis from breast cancer, as the skeleton is the most frequent site for metastases2, noting that there is a particular preference for the proximal femur3.
Contributed by Dr. Guilherme Pioli Resende M.D. and Dr. Arthemizio Antônio Lopes Rocha M.D.
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