Endometrial carcinoma presenting with an isolated osseous metastasis: a case report and review of the literature.

Endometrial carcinoma, the fourth most common cancer in women, is primarily a disease afflicting postmenopausal women and usually presents with vaginal bleeding or vaginal discharge. A slender, athletic 44-year-old woman was diagnosed with endometrial carcinoma after presenting with an isolated, solitary femoral bone metastasis. She had no symptoms except for progressive left knee pain. An open biopsy of the lesion in the proximal left femur revealed metastatic adenocarcinoma compatible with an endometrial primary. An endometrial biopsy subsequently revealed moderately differentiated endometrioid adenocarcinoma. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, and adjuvant chemotherapy. An aggressive metastatic workup revealed no other sites of metastatic disease. The femoral metastasis was treated with radiation. On chronic progestin therapy, the patient is clinically free of disease 2 years following diagnosis. Patients with endometrial carcinoma (with otherwise early stage disease) who present with an isolated skeletal lesion may represent an unusual group with perhaps a better prognosis. This patient received aggressive multi-disciplinary therapy and has had a two year progression-free interval.