Rare massive thoracic metastasis of endometrial cancer: Chest wall demolition and reconstruction. A case report.

INTRODUCTION

Distant recurrences are a major problem after surgical treatment for endometrial carcinoma; metastases to the bone are usually restricted to the axial skeleton, cases of costal localization are few. We present a case of a massive costal metastases successfully treated in our department.

CASE PRESENTATION

A 60-year-old woman underwent bilateral hysteroannessectomy followed by adjuvant radiotherapy for endometrial adenocarcinoma pT3a FIGO IIIA. Follow-up was uneventful until an occasional chest x-ray was made: a lesion of 7,5 × 5,4 × 5,6 cm in dimension was found at the left sixth rib, compatible with endometrial origin after biopsy. Despite chemo and radiotherapy the lesion incremented in size showing no response to treatment: 20 × 22 × 22 cm. Once she came to our attention, surgical treatment was planned after multidisciplinary discussion: we performed a left ribs V-IX en-block resection with the mass. We restored the chest wall using a biological prothesis in association with 3 titanium rib bars. The chest wall defect was covered with a myocutaneous flap (latissimus dorsi, serratus anterior, pectoralis major and obliquus externus). CLINICAL DISCUSSION: bone metastases from endometrial carcinoma are reported with a mean diameter of 5 cm; in our report the huge lesion represents a high-risk scenario for post-operative complications. In this setting surgical resection with complex multimodality reconstruction is needed.

CONCLUSIONS

This case is characterised by the rare localization and giant dimension of an endometrial metastasis. This report aims to describe the decision-making process, the successful demolition and reconstruction of the chest wall.