A man of 71 was seen with a solitary metastasis in the patella as the first presentation of carcinoma of the lung

Barbieri D

Cherubino P.

Pazzaglia U

PAZZAGLIA, Ugo

Archivio istituzionale della ricerca - Università di Brescia

International Orthopaedics (SICOT) (1989) 13:75-76 International Orthopaedics © Springer-Verlag 1989 Solitary metastasis of the patella as the first manifestation of lung cancer A case report U. E. Pazzaglia, D. Barbieri, and P. Cherubino Clinica Ortopedica dell'Universita die Pavia I.R.C.C.S. Policlinico San Matteo, Via Taramelli, 3, 1-27100 Pavia, Italy Summary. A man of 71 was seen with a solitary metastasis n the patella as the first presentation of carcinoma of the lung. R/~sum& Observation d'un homme de 71 ans, por- teur d'une m~tastase isolOe au niveau de la rotule, reprbsentant le premier sympt6me d'un cancer du poumon. A 71 year old man was admitted complaining of pain and swelling of the left knee for three months. He had suffered from angina pectoris for two years and had been a heavy smoker, but had ceased smoking for the previous two years. His past medical history was otherwise not significant. Physical examination revealed a painful swell- ing of the anterior surface of the patella, with lim- ited flexion of the knee and quadriceps wasting. Investigation by radiographs and computerised tomography revealed a lytic lesion destroying half of the patella and extending into the soft tissues (Fig. 1). Skeletal survey and bone scintigraphy confirmed that this was a solitary lesion. The Erythrocyte Sedimentation Rate was elevated and there was a normochromic anaemia. Other investigations, including a chest radiograph, were normal. Fig. 1. Computerized tomography shows destruction of the patella with invasion of soft tissues Fig. 2. (Haematoxylin-eosin, 240x) Histological specimen of the patella. Metastasis of epidermoid carcinoma Offprint requests to: U. E. Pazzaglia 76 Patellectomy and curettage of the soft tissues was performed. Histological examination of the specimen revealed a metastasis of epidermoid carcinoma, suggestive of a lung primary (Fig. 2). Lung tomography showed a mass in the left hilum and bronchoscopy with biopsy confirmed the di- agnosis of a primitive bronchial carcinoma. Discussion Tumours of the patella are rare and in most re- ported cases are osteoclastomas [1-4]. According to our knowledge metastases to the patella have not previously been reported. The diagnosis might U. E. Pazzaglia et al.: Solitary metastasis of the patella have been suspected in the presence of other bone metastases or of the primary tumour. The occur- rence of this solitary bone lesion as a first mani- festation of a lung carcinoma makes this case most unusual. References 1. Baldini N, Sudanese A (1984) Due casi di TGC della rotu- la. Chir Org Mov 69:271 2. Cole WH (1925) Primary Tumors of Patella. J Bone Joint Surg 7:637-654 3. Enneking WF (1983) Musculoskeletal Tumor Surgery. Churchill Livingstone, New York, pp 626 4. Linscheid RL, Dahlin DC (1966) Unusual Lesion of the Patella. J Bone Joint Surg [Am] 48: 1359-1365 

Solitary metastasis of the patella as the first manifestation of lung cancer. A case report.

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Archivio istituzionale della ricerca - Università di Brescia