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 vertebrae, ribs, and pelvis. By comparison, the clavicle is an extremely rare site of metastases in not only the population of lung cancers 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 preknown systemic disease had suffered from a sole intermittent right shoulder pain without any other discomfort for 3 months. Physical examination performed at our orthopedic department showed tenderness over right distal third of clavicle with limited range- of-motion of right shoulder. EGFR-mutated lung adenocarcinoma with metastasis over right clavicle resulting in a pathological fracture was diagnosed according to the result of incisional biopsy. Concurrent chemoradiation therapy accompanied with target therapy was performed.
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. Conclusions:
The 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.