Lung cancer is the fourth most common form of tumor spreading to the bone. Among all patients
of the lung carcinoma, the most common sites of bone metastasis are spine and ribs. By
comparison, the clavicle is an extremely rare site of metastases in not only the population of lung
cancer but among all type 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 systemic disease had suffered from a sole intermittent right
shoulder pain without any other discomfort for 3 months. Physical examination at our OPD,
tenderness over right distal third of clavicle with limited range-of-motion of right shoulder. EGFRmutated
lung adenocarcinoma with metastasis over right clavicle resulting in a pathological
fracture was confirmed with a serial of radiology and pathology diagnoses. Concurrent
chemoradiation therapy accompanied with target therapy was manipulated. 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.
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 unpleasant prognosis of clavicular metastasis from primary lung
adenocarcinoma, promising quality of life is achievable under multidisciplinary management.