Acute arthritis as an unusual complication of malignancy

Metastatic adenocarcinoma presenting as monoarticular arthritis of the knee: A case report with review of literature

Patients who develop metastatic arthritis secondary to solid tumors are rare. It is even more uncommon to be a presenting symptom. We present a case where a known case of osteoarthritic patient presented with complaints of knee swelling secondary to primary colonic carcinoma with lung metastasis. It was initially diagnosed on histopathology examination as metastatic adenocarcinoma from excised synovial mass and further investigated for primary carcinoma. Later, computed tomography was done and found out the primary colonic carcinoma arising from transverse colon along with lung metastasis.

Synovial metastasis of the knee in a KRAS mutant rectal adenocarcinoma patient

Synovial metastasis is an unusual entity in solid tumours and only a few cases have been reported in the literature. We report a case of synovial metastasis of the knee in a young patient with progressive rectal adenocarcinoma and review previously published case reports of synovial involvement in advanced colorectal carcinomas. Synovial metastasis is just one of the multiple possibilities of differential diagnosis in patients with cancer suffering from monarthritis. Radiological tests (plain radiographs, bone scans, MRI of the joint and so forth) can be unspecific and cytological examination of the synovial fluid and/or histology of synovial biopsies is essential for a definitive diagnosis so as to tailor the best treatment for patients. Given the poor prognosis associated with these intra-articular secondaries, treatment is often limited to palliation.

A case of spontaneous hip dislocation that occurred during radiation therapy

Currently, radiation therapy is widely used for the treatment and palliation of metastatic bone disease in both adults and children. Recent advances in radiation therapy, such as intensity-modulated radiation therapy, have led to more focused treatments and fewer adverse effects. Although radiation therapy has been associated with several musculoskeletal effects in the growing child, hip dislocation during a course of radiation therapy has not been reported. We report a case of a 12-year-old girl who presented with metastatic bone disease, and developed a hip dislocation during radiation therapy. Possible causes are discussed in detail and a thorough literature review is presented.

Synovial metastasis: an unusual cause of pain after total knee arthroplasty

There is only 1 previous report of synovial metastasis to a joint that has been replaced. A 73-year-old man presented for investigation of continuing pain after a left total knee arthroplasty with normal plain radiographs. Synovial biopsy revealed metastatic adenocarcinoma of colorectal type. A barium enema and flexible sigmoidoscopy showed a suspicious lesion at the rectosigmoid junction. The knee is the most frequently affected joint, and the lung is the most common primary site for synovial metastasis. This phenomenon should be considered in the differential diagnosis of continuing pain and effusion postarthroplasty.

Metastatic adenocarcinoma of the colon presenting as a monarthritis of the hip in a young patient

BACKGROUND

Malignant arthritis is a rare manifestation of metastatic disease. We describe the case of a previously well 28 year old man in whom hip pain was the presenting symptom of disease. We describe the case and discuss the aetiology of colorectal cancer in young patients. We then review the literature and discuss the investigation and management of malignant joint arthritis.

CASE PRESENTATION

We present the case of a 28 year old man who presented to the emergency department with an acute monoarthritis of the hip. He had an unremarkable past medical history and was systemically well. A diagnosis of malignant joint effusion was reached after a heightened index of clinical suspicion, magnetic resonance imaging and cytological evaluation of the synovial fluid. Computed tomography and bone scan confirmed widespread metastatic disease from a primary colonic adenocarcinoma. The patient tolerated three cycles of oxaliplatin and capecitabine but died 4 months after presentation.

CONCLUSION

The metastatic spread of cancer to the joint and the synovium is one of the rarest manifestations of malignant disease and has not been previously reported as the presenting symptom of disease. The diagnosis is a difficult one to reach and is associated with a poor prognosis. This case illustrates the importance of thorough investigation in reaching this diagnosis and entertaining the possibility in individuals who do not respond to conventional management of acute monoarthritis, even in young patients and individuals who do not display any other symptoms of disease.

Acute arthritis of carpal bones secondary to metastatic gastric cancer

A 39-year-old woman presented with acute onset of arthralgia in both wrists. Although her primary gastric cancer was in remission after previous treatment, carcinomatous arthritis was suggested by the osteolytic radiographic findings and refractoriness to nonsteroidal anti-inflammatory drugs, which was then confirmed by synovial fluid cytopathology. In view of the high incidence of gastric cancer in Korea, gastric cancer involving the carpal bones should be considered when we encounter a patient presenting with inflammatory peripheral joint arthritis, which might be the first sign of recurrence.