GEÇ BAŞLAYAN, SOLİTER KEMİK METASTAZI İLE PREZENTE OLAN PROKSİMAL HUMERUS LEZYONU: 12 YILLIK REMİSYONDAN SONRA TANISAL BİR ZORLUK

Yıl 2025, Cilt: 34 Sayı: 2, 307 - 311, 15.08.2025

Omer Esmez , Merve Yıldız Esmez , Gülnihal Deniz

https://doi.org/10.34108/eujhs.1675225

Öz

Meme kanseri kadınlarda en sık görülen tümörlerden biridir. Her sekiz kadından biri hayatının bir noktasında bu hastalıkla karşılaşabilir ve metastaz, uzun yıllar süren remisyondan sonra bile gelişebilir. Bu olgu sunumunda, 2012'nin başlarında sol memede karma tip (invaziv duktal ve lobüler) karsinomu teşhisi konulan ve 12 yıl remisyon boyunca modifiye radikal mastektomi ve adjuvan tedaviler uygulanan 60'lı yaşlarındaki bir kadında sağ omuzda ağrı ve şişlikle ortaya çıkan nadir bir humerus metastazı anlatılmaktadır. Pozitron emisyon tomografisi görüntüleme, proksimal sağ humerusta hipermetabolik bir lezyon ortaya koydu. Manyetik rezonans görüntüleme ve biyopsi, metastatik meme kanserini gösteren kötü huylu bir epitel tümör ortaya koydu. Hastaya palyatif radyoterapi uygulandı ve sistemik tedavi olarak ribociclib (Valamor) başlandı. Ancak, tedavi nedeniyle ellerde ve yüzde yaygın kaşıntı ve vitiligo benzeri cilt değişiklikleri gelişti. Bu vaka, meme kanseri hastalarında uzun dönem klinik ve radyolojik takibin önemini ve geç dönemde ortaya çıkabilecek iskelet metastazlarına karşı dikkatli olunması gerektiğini vurgulamaktadır.

Anahtar Kelimeler

Kemik metastazı , meme neoplazileri , humerus , lobüler karsinom , geç nüks.

LATE-ONSET PROXIMAL HUMERUS LESION PRESENTING WITH SOLITARY BONE METASTASIS: A DIAGNOSTIC CHALLENGE AFTER 12 YEARS OF REMISSION

Öz

Breast cancer is one of the most common tumors in women. One in eight women may encounter this disease at some point in their lives, and metastasis may develop even after many years of remission. This case report describes a rare humerus metastasis presenting with pain and swelling in the right shoulder in a woman in her 60s who was diagnosed with mixed-type (invasive ductal and lobular) carcinoma of the left breast in early 2012 and who underwent modified radical mastectomy and adjuvant treatments for 12 years of remission. Positron emission tomography imaging revealed a hyper metabolic lesion in the proximal right humerus. Magnetic resonance imaging and biopsy revealed a malignant epithelial tumor indicating metastatic breast cancer. The patient underwent palliative radiotherapy and was started on ribociclib (Valamor) as systemic treatment. However, widespread itching and vitiligo-like skin changes developed on the hands and face due to the treatment. This case emphasizes the importance of long-term clinical and radiological follow-up and the need to be careful about skeletal metastases that may occur in the late period in breast cancer patients.

Anahtar Kelimeler

Bone neoplasms , breast neoplasms , humerus , lobular carcinoma , neoplasm recurrence.

Teşekkür

We would like to express our sincere gratitude to our patient and our patient's wonderful family for their support and cooperation.

Kaynakça

• Singh I, Krasney L, Civatte W, Parrish W, Krasney LC. Treatment of epiphyseal metastasis to the proximal humerus secondary to breast carcinoma: a case report. Cureus. 2023;15(10):e47564. doi:10.7759/cureus.47564
• Horache K, Jidal M, Sidki K, Omor Y, Latib R, Amalik S. Uncommon orbital metastasis in ductal breast carcinoma: a rare presentation 12 years after treatment. J Surg Case Rep. 2024;2024(6):rjae428. doi:10.1093/jscr/rjae428
• Sountoulides P, Metaxa L, Asouhidou I, Stavropoulos M, Calleary J. Very low risk T1a renal cell carcinoma presenting with pathological fracture caused by a solitary metastases to the contralateral arm. Urol J. 2022;89(2):307–10. doi:10.1177/03915603211007059
• Cheung H, Yechoor A, Behnia F, Abadi AB, Khodarahmi I, Soltanolkotabi M, et al. Common skeletal neoplasms and nonneoplastic lesions at 18F-FDG PET/CT. Radiographics. 2022;42(1):250–67. doi:10.1148/rg.210090
• Lebron L, Greenspan D, Pandit-Taskar N. PET imaging of breast cancer: role in patient management. PET Clin. 2015;10(2):159–95. doi:10.1016/j.cpet.2014.12.004
• Zamanian M, Treglia G, Abedi I. Diagnostic accuracy of PET with different radiotracers versus bone scintigraphy for detecting bone metastases of breast cancer: a systematic review and a meta-analysis. J Imaging. 2023;9(12):274. doi:10.3390/jimaging9120274
• Tahara RK, Brewer TM, Theriault RL, Ueno NT. Bone metastasis of breast cancer. In: Ahmad A, editor. Breast cancer metastasis and drug resistance: challenges and progress. Cham: Springer; 2019. p.105–29. doi:10.1007/978-3-030-20301-6_7
• Confavreux CB, Follet H, Mitton D, Pialat JB, Clezardin P. Fracture risk evaluation of bone metastases: a burning issue. Cancers (Basel). 2021;13(22):5711. doi:10.3390/cancers13225711
• Pan H, Gray R, Braybrooke J, Davies C, Taylor C, McGale P, et al. 20-year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. N Engl J Med. 2017;377(19):1836–46. doi:10.1056/NEJMoa1701830
• Anampa JD, Lin S, Obeng-Gyasi S, Xue X. Treatment and survival differences between patients with invasive lobular carcinoma versus invasive ductal carcinoma of the breast. Cancer Epidemiol Biomarkers Prev. 2025;34(1):125–32. doi:10.1158/1055-9965.EPI-24-1250
• Li X, Febres-Aldana C, Zhang H, Zhang X, Uraizee I, Tang P. Updates on lobular neoplasms and papillary, adenomyoepithelial, and fibroepithelial lesions of the breast. Arch Pathol Lab Med. 2022;146(8):930–9. doi:10.5858/arpa.2021-0091-RA
• Aljarrah A, Al-Hashmi M, Malik KA, Sukhpal S, Hussein S, Al-Riyami M, et al. Mucinous breast cancer with solitary metastasis to humeral head: a case report. Oman Med J. 2013;28(5):350–3. doi:10.5001/omj.2013.100
• Pang L, Gan C, Xu J, Jia Y, Chai J, Huang R, et al. Bone metastasis of breast cancer: molecular mechanisms and therapeutic strategies. Cancers (Basel). 2022;14(23):5727. doi:10.3390/cancers14235727
• Coleman RE, Croucher PI, Padhani AR, Clézardin P, Chow E, Fallon M, et al. Bone metastases. Nat Rev Dis Primers. 2020;6(1):83. doi:10.1038/s41572-020-00216-3