An Unusual Solitary Metatarsal Metastasis from an Endometrioid Endometrial Adenocarcinoma

Endometrial cancer is the fourth most common tumor in women. Abnormal uterine bleeding is the leading symptom in 90% of cases. The more frequent metastatic sites include lymph nodes, omentum, lungs, and liver. Bone metastasis has been reported to occur in 2-6% of all metastatic endometrial cancers, particularly in high surgical stage and grade, the most common involved site being the spine and hip.

We report here the case of a 62-year-old white woman hospitalized for a painful swelling in the left foot, which appeared from January 2014, postmenopausal bleeding, and a progressive weight loss in the last year. An endometrioid, endometrial cancer was diagnosed by hysteroscopy, associated with a solitary bone metastasis of the left metatarsus, histologically confirmed by biopsy. The patient refused any surgical procedure. She received a single-fraction of 800 cGy radiotherapy to the left foot, leading to optimal analgesic control. Subsequently, systemic chemotherapy was started using a carboplatin/paclitaxel-containing regimen with IV zoledronic acid. This treatment is ongoing.

There is no standard treatment for endometrial cancer bone metastasis. The prognosis of these patients is poor, with a median survival of about 12-17 months. The treatment is predominantly palliative and relies on several factors, including patient clinical conditions, site and number of bone metastases, and the presence of any additional visceral lesions. An aggressive multimodal treatment should be proposed to very select patients presenting better prognostic factors. In our case, a solitary fifth metatarsal bone metastasis, histologically proved, was shown as initial presentation of an EC. Endometrial cancer can present as initial bone diffusion, even in atypical locations such as acrometastasis and it should be considered when bone metastases are diagnosed.