Unusual metastatic pattern of endometrial carcinoma with distal foot involvement

Abstract

Introduction: Endometrial carcinoma typically metastasizes to the lungs, liver, and bones of the axial skeleton. Metastatic spread to the bones of the foot is exceedingly rare and may present with nonspecific musculoskeletal symptoms, often mimicking infection. Recognizing such atypical metastatic patterns is essential for timely diagnosis and management, particularly in patients with high-risk disease.

Case report: A 62-year-old woman with FIGO stage IIIB endometrioid adenocarcinoma, previously treated with surgery and radiotherapy, presented with progressive pain and swelling of the right foot. Initial clinical evaluation suggested cellulitis, and empiric antibiotics were started. Symptoms persisted, prompting further investigation. MRI demonstrated diffuse marrow abnormalities and cortical disruption in multiple tarsal bones, raising suspicion for malignancy. Biopsy confirmed metastatic endometrioid adenocarcinoma. FDG PET-CT revealed intense uptake in the foot lesion, as well as additional FDG-avid lesions in the right femur, fibula, metatarsal, and a pulmonary nodule, consistent with widespread metastatic disease.

Conclusion: Metastases to the bones of the foot from endometrial carcinoma are rare and can mimic infection. This case highlights the importance of maintaining a high index of suspicion for unusual metastatic patterns in patients with persistent musculoskeletal symptoms and a history of high-risk endometrial cancer. Timely imaging and histologic confirmation are critical for accurate diagnosis and appropriate management, especially as such presentations often indicate advanced systemic disease.

Keywords: Endometrial cancer; FDG PET/CT; Foot metastasis; MRI.

Fig. 1

MRI of the right foot and FDG-PET-CT. A) Unenhanced T1 of the right foot showing extensive bone marrow abnormalities in navicular, cuboid, lateral cuneiform bones with cortical disruption and soft tissue extension. B) Contrast enhanced T1 showing extensive enhancement of the lesions. C) CT of the foot shows extensive masses in the tarsalia of the right foot. D) Fused with FDG-PET displays intense FDG-uptake in the tarsal masses. E) MIP of the FDG-PET shows additional metastasis in the right tibia, right femur, right lung and possible in the right iliopsoas muscle.