Abstract
BackgroundA case of metastatic carcinoma secondary to urothelial carcinoma presenting as musculoskeletal pain is reported. A brief review of urothelial and metastatic carcinoma including clinical presentation, diagnostic testing, treatment and chiropractic considerations is discussed.Case presentationThis patient presented in November 2014 with progressive neck, thorax and upper extremity pain. Computed tomography revealed a destructive soft tissue mass in the cervical spine and additional lytic lesion of the 1st rib. Prompt referral was made for surgical consultation and medical management.ConclusionDistant metastasis is rare, but can present as a musculoskeletal complaint. History of carcinoma should alert the treating chiropractic physician to potential for serious disease processes.
Highlights
A case of metastatic carcinoma secondary to urothelial carcinoma presenting as musculoskeletal pain is reported
Studies confirm that bone is the preferred site of metastasis (35 %) of Urothelial carcinoma (UC) outside of the pelvis, with the spine being most common site (40 percent of bone metastases) [7]
The objective of this case report is to describe a patient presenting for chiropractic care with neck, arm and thorax pain due to metastatic disease secondary to urothelial carcinoma and provide brief review including clinical presentation, diagnosis, and treatment
Summary
Urothelial carcinoma (UC), known as transitional cell carcinoma (TCC), accounts for more than 90 % of all bladder cancers and commonly metastasizes to the pelvic lymph nodes, lungs, liver, bones and adrenals or brain [1, 2]. A recent systematic review identified more than 60 published cases of diverse cancers recognized by chiropractic physicians [15] The objective of this case report is to describe a patient presenting for chiropractic care with neck, arm and thorax pain due to metastatic disease secondary to urothelial carcinoma and provide brief review including clinical presentation, diagnosis, and treatment. Relevant medical history included concurrent care for high-grade papillary transitional cell carcinoma (TCC) of the bladder, and presence of a pacemaker. He was a 50-year non-smoker, but with a 30-pack year history of cigarette use. The patient expired 4-weeks following the discovery of these lesions on the CT scan
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