Korean J Sports Med.  2016 Dec;34(2):181-184. 10.5763/kjsm.2016.34.2.181.

A Metastatic Lung Adnocarcinoma Misdiagnosed as Trauma Induced Sternoclavicular Joint Arthrosis

• Kim JH
• Yoo JH
• Kwak HI
• Song SH
• Kim JY

• KMID: 2382057
• DOI: http://doi.org/10.5763/kjsm.2016.34.2.181

Abstract

The prevalence of metastatic tumorous lesion at medial clavicle or sternoclavicular joint is low. Herein, we presented a 45-year-old female patient with left sternoclavicular joint pain followed a weight-lifting exercise. The patient was initially diagnosed as traumatic sternoclavicular arthrosis, however, on later computed tomography scan demonstrated the bony destruction of medial clavicle which was diagnosed as metastasized non-small cell lung carcinoma after a fine needle biopsy.

Keyword

Lung cancer; Sternoclavicular; Arthrosis; Metastasis; Adenocarcinoma

MeSH Terms

Adenocarcinoma
Biopsy, Fine-Needle
Clavicle
Female
Humans
Lung Neoplasms
Lung*
Middle Aged
Neoplasm Metastasis
Prevalence
Sternoclavicular Joint*

Figure

• 

  Fig. 1. No specific abnormality was observed on clavicular X-ray at first visit (A). However, the periarticular soft tissue swelling with subcutaneous fat infiltration was observed at left sternoclavicular joint (white arrow) (B).

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  Fig. 2. The periarticular soft tissue swelling with subcutaneous fat infiltration was observed at left sternoclavicular joint after 2 month (white arrow) (A). With 2-month interval, the osterolysis with sternoclavicular joint destruction was progressed rapidly (white arrow) (B). The destructive pattern of medial clavicle was observed at 4-month follow-up after the first visit (C).

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  Fig. 3. A bony expansile and osteolytic solid mass lesion with heterogenity on medial end of left clavicle with 3.1×3.6×2.8 cm size was observed on ultrasonography (A) and no intralesional vascularity was observed by color Doppler study (B).

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  Fig. 4. Adenocarcinoma with subtle papillary pattern (asterisks) was noticed on H&E stain of core biopsied tissue (H&E, ×200).

Reference

References

1. Petrov D, Marchalik D, Lipsky A, Milgraum S. Asymptomatic enlargement of the clavicle: a review of underlying aetiologies. Acta Orthop Belg. 2010; 76:715–8.

2. Robinson CM, Jenkins PJ, Markham PE, Beggs I. Disorders of the sternoclavicular joint. J Bone Joint Surg Br. 2008; 90:685–96.

3. Sugiura H, Yamada K, Sugiura T, Hida T, Mitsudomi T. Predictors of survival in patients with bone metastasis of lung cancer. Clin Orthop Relat Res. 2008; 466:729–36.

4. Dennis JL, Hvidsten TR, Wit EC, et al. Markers of adenocarcinoma characteristic of the site of origin: development of a diagnostic algorithm. Clin Cancer Res. 2005; 11:3766–72.

5. Welsh JW, Komaki R, Amini A, et al. Phase II trial of erlotinib plus concurrent whole-brain radiation therapy for patients with brain metastases from non-small-cell lung cancer. J Clin Oncol. 2013; 31:895–902.

6. Sewell MD, Al-Hadithy N, Le Leu A, Lambert SM. Instability of the sternoclavicular joint: current concepts in classification, treatment and outcomes. Bone Joint J. 2013; 95:721–31.

7. Shenoy R, Pillai A, Ried R, Tansey P. Primary bone tumors and tumor like lesions of the clavicle. Orthop proc. 2006; 88:297–8.

8. Kapoor S, Tiwari A, Kapoor S. Primary tumours and tumorous lesions of clavicle. Int Orthop. 2008; 32:829–34.