Bakula Branko, Karačić Andrija, Stanić Gabrijela, Romić Ivan, Bakula Mirko, Bogut Ante
Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia.
Department of Pathology, University Hospital Sveti Duh, Zagreb, Croatia.
Prz Gastroenterol. 2023;18(1):115-122. doi: 10.5114/pg.2023.126044. Epub 2023 Mar 24.
Solitary bone metastasis of colorectal carcinoma (CRC) without other metastasis sites is extremely rare and can be found in less than 1% of patients with CRC.
In the present study, we report the first case of a solitary tibia metastasis and its pathologic fracture as the first presenting feature of a colorectal adenocarcinoma.
A 78-year-old female patient presented to our emergency department due to atraumatic pretibial swelling. Plain radiography did not detect any pathology. The swelling was incised and serous-bloody collection was evacuated, and the patient was discharged. On the 17 postoperative day, during a regular walk, the patient fell down and broke her leg, which transpired to be a pathologic fracture of the proximal tibial diaphysis, confirmed by X-ray. A biopsy of the altered bone tissue from the fracture site revealed metastatic colorectal adenocarcinoma. On colonoscopy, a circular mass in the upper rectum was found.
Solitary bone metastases are most commonly found in bones that are related to venous drainage via the paravertebral plexus of Batson - the pelvis, vertebrae, and sacrum. Long bones are extremely rare localizations of solitary CRC metastases, with only few cases published so far in medical literature. In our case, the patient`s first symptom was related to the osseous tibial metastasis - leg swelling. No tumour was suspected until the pathologic fracture occurred. It is important to consider osseous metastasis in every patient with unexplained swelling, haematoma, or pain of the extremities and make a bone scan to recognize the metastasis early.
结直肠癌（CRC）无其他转移部位的孤立性骨转移极为罕见，在CRC患者中发现率不到1%。
在本研究中，我们报告首例以孤立性胫骨转移及其病理性骨折为首发表现的结直肠腺癌病例。
一名78岁女性患者因非创伤性胫前肿胀就诊于我院急诊科。X线平片未发现任何病变。切开肿胀部位，引出浆液性血性液体后患者出院。术后第17天，患者在正常行走时摔倒，腿部骨折，经X线证实为胫骨近端骨干病理性骨折。骨折部位病变骨组织活检显示为转移性结直肠腺癌。结肠镜检查发现直肠上段有一圆形肿物。
孤立性骨转移最常见于通过Batson椎旁静脉丛引流的骨骼——骨盆、椎骨和骶骨。长骨是孤立性CRC转移极为罕见的部位，医学文献中迄今仅发表了少数病例。在我们的病例中，患者的首发症状与胫骨骨转移有关——腿部肿胀。直到发生病理性骨折才怀疑有肿瘤。对于每一位出现不明原因的肢体肿胀、血肿或疼痛的患者，考虑骨转移并进行骨扫描以早期识别转移非常重要。
