Abstract
Advanced lung cancer is complicated by skeletal metastases either due to direct extension from adjacent primaries or, more commonly, due to haematogenous dissemination of neoplastic cells. Lumber spine is the most common site for bony metastases in bronchogenic carcinoma. Proximal lone bones, especially humerus, are unusual sites for metastases from lung primaries. Small cell and large cell varieties of lung cancer are most commonly associated with skeletal dissemination. It is also unusual that an asymptomatic squamous cell carcinoma of lung presents with painful, soft tissue swelling with osteolytic metastasis of humerus which is reported in our case. Systemic cytotoxic chemotherapy, local palliative radiotherapy, adequate analgesia, and internal fixation of the affected long bone are different modalities of treatment in this advanced stage of disease. But the prognosis is definitely poor in this stage IV disease.
Highlights
The skeleton is a common site for metastases from epithelial tumours
A very few reports of metastasis to humerus in bronchogenic carcinoma are available in the literature
We report a rare case of bronchogenic carcinoma metastasizing to humerus and, surprisingly, the patient presented with a painful swelling of the left arm without any respiratory symptom
Summary
The skeleton is a common site for metastases from epithelial tumours. Most common malignancies which present with bone metastases are carcinomas of prostate, breast, and lung [1]. We report a rare case of bronchogenic carcinoma metastasizing to humerus and, surprisingly, the patient presented with a painful swelling of the left arm without any respiratory symptom. Chemoradiotherapy was a very good option for palliation of the malignant bone pain, in our patient, size of the primary lung tumour was gradually increasing (as evidenced by serial CXRs) and pain of the osteolytic lesion of left humerus was not relieved, though the size of the lesion reduced marginally. After first cycle of chemotherapy amputation of upper limb was done in the department of orthopaedics, and histopathological examination of resected specimen showed metastatic squamous cell carcinoma of the bone (Figure 6). He succumbed to his illness after second cycle of chemotherapy
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