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Fibula metastasis as the presenting feature of vaginal cancer.

BACKGROUND
Metastatic bone involvement in vaginal carcinoma has not been reported in the literature.


CASE
A 74-year-old woman was referred for a painful fibula to the orthopedic surgeon. A work-up revealed an isolated metastatic bone lesion in the right fibula of a primary squamous carcinoma of the vagina. Rather surprisingly this lesion had been missed during all previously regular clinical gynecological examinations. Palliative therapy including bone resection and radiotherapy of the metastatic lesion were given.


CONCLUSION
This case highlights: (1) the unique presentation of a vaginal cancer by pain in the lower leg secondary to a metastasis in the fibula; (2) that a speculum examination can mask a mid-vaginal lesion; (3) the importance of aggressive treatment of a solitary bone metastasis in order to provide effective palliation.