Fui Bee Woo, Shing Wei Chew, Nai Chien Huan, Joon Hi Tham

Silent lungs, aching knee: Isolated knee pain as the initial presentation of lung adenocarcinoma

Introduction

Silent lungs, aching knee: isolated knee pain as the initial presentation of lung adenocarcinoma. Discover a rare case where isolated knee pain, caused by bone metastasis, was the initial symptom of lung adenocarcinoma. Learn about the diagnosis and successful targeted therapy.

Abstract

Lung cancer is a leading cause of cancer-related mortality globally, with most patients being diagnosed at advanced stages. While bone metastasis is common, the presentation of a solid long bone tumour as the first sign of lung adenocarcinoma is unusual. This single-case report describes a 66-year-old female who presented with gradual onset of right knee pain following a fall six months ago. Magnetic resonance imaging (MRI) of the right knee revealed a destructive lesion at the distal femur. Bone biopsy confirmed metastatic adenocarcinoma originating from the lung, with epidermal growth factor receptor (EGFR) exon 19 deletion gene mutation identified. The patient showed significant improvement following a combination of targeted therapy and radiotherapy. Follow-up computed tomography (CT) revealed a reduction in the size of the primary tumour and regression of the bone lesion, rendering the patient symptom-free.

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