Rare massive thoracic metastasis of endometrial cancer: Chest wall demolition and reconstruction. A case report

Introduction: Distant recurrences are a major problem after surgical treatment for endometrial carcinoma; metastases to the bone are usually restricted to the axial skeleton, cases of costal localization are few. We present a case of a massive costal metastases successfully treated in our department. Case presentation: A 60-year-old woman underwent bilateral hysteroannessectomy followed by adjuvant radiotherapy for endometrial adenocarcinoma pT3a FIGO IIIA. Follow-up was uneventful until an occasional chest x-ray was made: a lesion of 7,5 × 5,4 × 5,6 cm in dimension was found at the left sixth rib, compatible with endometrial origin after biopsy. Despite chemo and radiotherapy the lesion incremented in size showing no response to treatment: 20 × 22 × 22 cm. Once she came to our attention, surgical treatment was planned after multidisciplinary discussion: we performed a left ribs V-IX en-block resection with the mass. We restored the chest wall using a biological prothesis in association with 3 titanium rib bars. The chest wall defect was covered with a myocutaneous flap (latissimus dorsi, serratus anterior, pectoralis major and obliquus externus). Clinical discussion: bone metastases from endometrial carcinoma are reported with a mean diameter of 5 cm; in our report the huge lesion represents a high-risk scenario for post-operative complications. In this setting surgical resection with complex multimodality reconstruction is needed. Conclusions: This case is characterised by the rare localization and giant dimension of an endometrial metastasis. This report aims to describe the decision-making process, the successful demolition and reconstruction of the chest wall.