Burlone Antonio, Tombelli Simone, Viggiano Domenico, Borgianni Sara, Gonfiotti Alessandro
Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla 1, 50134 Florence, Italy.
Int J Surg Case Rep. 2025 Feb;127:110825. doi: 10.1016/j.ijscr.2025.110825. Epub 2025 Jan 4.
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.
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.
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.
远处复发是子宫内膜癌手术治疗后的一个主要问题；骨转移通常局限于中轴骨骼，肋部转移的病例较少。我们报告了1例在我科成功治疗的巨大肋部转移病例。
一名60岁女性因子宫内膜样腺癌pT3a FIGO IIIA期接受了双侧子宫附件切除术及辅助放疗。随访期间一直无异常，直到偶然进行胸部X光检查时发现：左侧第六肋骨处有一个大小为7.5×5.4×5.6厘米的病灶，活检后发现与子宫内膜来源相符。尽管进行了化疗和放疗，病灶仍增大，对治疗无反应，大小变为20×22×22厘米。在引起我们的注意后，经多学科讨论后计划进行手术治疗：我们对左侧第五至第九肋骨进行了整块切除并切除肿物。我们使用生物假体联合3根钛制肋骨条修复胸壁。胸壁缺损用肌皮瓣（背阔肌、前锯肌、胸大肌和腹外斜肌）覆盖。
子宫内膜癌骨转移报告的平均直径为5厘米；在我们的报告中，巨大的病灶代表了术后并发症的高风险情况。在这种情况下，需要进行复杂多模式重建的手术切除。
该病例的特点是子宫内膜转移的罕见部位和巨大尺寸。本报告旨在描述决策过程、胸壁的成功切除和重建。
