International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - vol 05 issue 19, October, 2013

Pages: 56-60

Date of Publication: 19-Oct-2013

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Author: Supradeeptha Challa, Vikram Kumar Kadiyam, Kota Aditya, Satyaprasad J.

Category: Healthcare

Abstract:Metastasis of lung carcinoma to proximal ulna is very rare. We report a case of 55 year male patient with adenocarcinoma of lung, with metastasis to proximal ulna.

Keywords: adenocarcinoma lung, metastasis.

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Bone is one of the most common locations for metastasis1. While any type of carcinoma is capable of forming metastasis within bone, the microenvironment of the marrow tends to favor particular types of cancer, including prostate, breast, and lung carcinoma2. Particularly in prostate carcinoma, bone metastases tend to be the only site of metastasis3.

Bone metastases most commonly affect the axial skeleton. The axial skeleton contains the red marrow, while appendicular skeleton contains relatively fatty marrow4. The drainage of blood to the skeleton via the vertebral-venous plexus may, at least in part, explain the tendency of breast and prostate, kidney, thyroid, and lung cancers, to produce metastases in the axial skeleton and limb girdles5. The vertebral-venous plexus does not provide the entire explanation of why these cancers metastasize to the skeleton. Molecular and cellular biological characteristics of the tumor cells and the tissues to which they metastasize are of paramount importance and influence the pattern of metastatic spread6-8.

Skeletal metastases account for 70% of all malignant bone tumours9. The incidence of bone metastases from lung carcinoma is 36%10. The frequency of bone metastasis is significantly higher among patients with adenocarcinoma than small cell or squamous carcinoma11, 12. Because of the relatively avascular marrow, metastases below the elbow and knee are relatively rare13. No case report of adenocarcinoma lung with secondaries to proximal ulna is published till date except in felines14.


A 55 year old male patient came to department of Orthopaedics with complaints of pain and swelling at right elbow and forearm since 2 months which is insidious in onset and gradually progressing. Pain is of diffuse in elbow region, stabbing in nature, non-radiating, severe with movements of elbow, and rated 7/10 on a visual analogue score. Patient had no history of trauma. Additional symptoms included mild shortness of breath. Patient is a smoker (1 packet beedies/day) and alcoholic (90 ml/day). The patient was afebrile. Vital signs were normal. Respiration is 19 cycles per minute. On auscultation of lungs, there is mild decrease in breath sound on right side of chest.  On inspection of the forearm, there is diffuse swelling at right elbow and forearm of size 12x6 cms. Skin over swelling darkened, shiny. No scars, no sinuses, no visible pulsations.

On palpation, local rise of temperature present. Severe tenderness present over olecranon which is irregular in outline. Radial head is not palpable. Swelling is hard to firm in nature, pitting edema present, skin not pinchable over swelling. Distal radial pulse felt. No distal neurological deficits. Mild decrease in flexion of elbow and other movements are normal. Radiographs of right forearm showing osteolytic lesion of proximal ulna extending into diaphysis (Figure 1 and2). Articular surfaces are maintained. Radiograph of chest showing radio dense lesion in right lung (Fig 3).

FNAC Smears (Figure 4) from lytic lesions of right ulna shows abundant cellularity of cuboidal cells arranged in small and large clusters, sheets and papilloid structures and also scattered discretely. At places, these cells show acinar or microfollicular arrangement. The nuclei are large hyperchromatic with well dispersed chromatin and prominent nucleoli cytoplasm is densely eosinophilic. These features suggestive of metastasis of adenocarcinoma of  lung to proximal ulna. The FNAC report of right supraclavicular lymphnodes shows same features.  Patient was referred to cancer trust hospital for further management. 


Lung cancer can metastasize to virtually any bone, although the axial skeleton and proximal long bones are most commonly involved15. Metastatic tumor cells colonize the bone matrix and stimulate the activity of osteoclasts and/or osteoblasts, causing osteolysis and possible excessive bone formation around sites of tumor cell deposits in bone. This disruption in bone metabolism leads to significant skeletal morbidity most commonly bone pain16. To our knowledge, this is the first case report of adenocarcinoma lung metastasis to proximal ulna.


Metastasis of adenocarcinoma to ulna is very rare.


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A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
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A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
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A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

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A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19

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