Presentation
Unable to weight bear with pelvis/hip pain.
Patient Data
Alignment within normal limits. Multiple lytic lesions in the proximal left femur and a probable lesser trochanter fracture. No other fracture is seen.
On the delayed images, moderately intense tracer uptake is noted in the right subtrochanteric region. No other suspicious foci are seen elsewhere.
Expansile lytic lesion centered on the right lesser trochanter with cortical destruction and thinning. Central soft tissue density. Lucency through the base of the lesser trochanter in keeping with a pathological fracture. There are multiple other cortically based lytic lesions within the right proximal femoral metadiaphysis.
CT guided bone biopsy was performed.
Histology
MICROSCOPIC DESCRIPTION: The biopsy shows reactive woven bone infiltrated by carcinoma comprising sheets, nests and trabeculae and of moderately pleomorphic epithelial cells within fibrotic stroma.
DIAGNOSIS: Right femur biopsy: Metastatic carcinoma.
Case Discussion
Isolated lesser trochanter fractures in adults should be considered pathological until proven otherwise. In elderly patients, the most common lesions are metastasis, myeloma or lymphoma. This patient had a history of breast cancer treated a few years ago.
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