Colon adenocarcinoma first presenting as shoulder pain. Case report

Bone metastases of colorectal cancer (CRC) are uncommon and usually occur in the context of a widespread disease. A 77-year-old woman presented with increasing pain in the right shoulder which had started 5 months earlier. On examination, a hard mass arising from the right scapula was found. There were no other abnormal findings on body Computerized Tomography (CT). A biopsy confirmed a metastatic adenocarcinoma. Further colonoscopy revealed a colonic obstructive tumour. Both solitary metastasis and the primary tumour were treated, and patient maintains a progression-free status. This is an unusual form of presentation for a colon cancer. With this report we aimed to discuss the unique clinical and pathological features of this colonic cancer and call attention of the physicians' community for this atypical presentation. Isolated bone metastasis in CRC is a rare entity and there are only a few similar cases reported in the literature.