Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
Department of Materials and Textiles, Oriental Institute of Technology, New Taipei City, Taiwan, ROC.
Eur J Med Res. 2021 Feb 27;26(1):23. doi: 10.1186/s40001-021-00493-y.
Lung cancer is the fourth most common form of the tumor spreading to the bone. Among all patients of lung carcinoma, the most common sites of bone metastasis are vertebrae, ribs, and pelvis. By comparison, the clavicle is an extremely rare site of metastases not only in the population of lung cancers but among all types of tumors. Enlightened by this existing fact, we would like to share our experience of management of an uncommon clavicular metastasis and illuminate the obscure mechanism of its scarcity.
A 56-year-old female without any preknown systemic disease had suffered from a sole intermittent right shoulder pain without any other discomfort for 3 months. Physical examination performed at our orthopedic department showed tenderness over the right distal third of the clavicle with limited range-of-motion of the right shoulder. EGFR-mutated lung adenocarcinoma with metastasis over the right clavicle resulting in a pathological fracture was diagnosed according to the result of the incisional biopsy. Concurrent chemoradiation therapy accompanied with target therapy was performed. Eighteen months postoperatively, the clavicle pain was found to be subsided with stationary bony lesion under appropriate medication and palliative radiotherapy during the subsequent follow-up.
The clavicle is an exceedingly unusual site with 2% of metastatic involvement of all type of tumors and only 1% among the population of carcinoma of lung due to its scanty red marrow and sparse vascular supply. Despite the unpleasant prognosis of clavicular metastasis from primary lung adenocarcinoma, promising quality of life is achievable under multidisciplinary management.
肺癌是第四种最常见的肿瘤转移至骨骼的类型。在所有肺癌患者中，最常见的骨转移部位是椎体、肋骨和骨盆。相比之下，锁骨不仅是肺癌人群中，也是所有肿瘤类型中转移的极罕见部位。鉴于这一现有事实，我们想分享我们对一种罕见锁骨转移的治疗经验，并阐明其罕见性的模糊机制。
一名 56 岁女性，无任何已知的系统性疾病，仅出现间歇性右肩部单一疼痛，无其他不适，持续 3 个月。在我们的骨科部门进行的体格检查显示，右锁骨远端三分之一处有压痛，右肩关节活动范围受限。根据切开活检结果，诊断为 EGFR 突变型肺腺癌伴右锁骨转移导致病理性骨折。随后进行了同步放化疗联合靶向治疗。术后 18 个月，在适当的药物和姑息性放疗治疗下，锁骨疼痛减轻，骨病变稳定。
由于锁骨红骨髓稀少，血管供应稀疏，因此转移发生率非常低，在所有类型的肿瘤中占 2%，在肺癌人群中占 1%。尽管原发性肺腺癌锁骨转移的预后不佳，但通过多学科管理可实现良好的生活质量。
