Approach to a Focal Bone Lesion Above Age 45 – Proximal Humerus Metastasis from Ca Endometrium

This is a 67-years old lady with a past history of Ca endometrium, which was elicited only at the time of the PET/CT.

She presented with pain in the right shoulder. The MRI showed a focal lesion in the proximal humerus. A radiograph thereafter showed an aggressive lesion. She was sent for a biopsy.
I argued that this was likely metastatic or myeloma and asked for a PET/CT. At the time of the PET/CT, it was found that she had a past history of Ca endometrium. The PET also showed lung nodules and a right iliac bone lesion.
The question now was, what should be biopsied. While the right iliac bone lesion is also simple, the proximal humerus lesion is easier. Using an 18-G coaxial biopsy gun, the procedure was performed with local anesthesia and periosteal infiltration.
The diagnosis was adenocarcinoma consistent with metastasis from Ca endometrium.