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LETTER TO EDITOR
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Year : 2010  |  Volume : 47  |  Issue : 4  |  Page : 475-

Pathologic fracture of the odontoid as the presenting sign of metastatic cancer

MS Walid, M Sanoufa 
 Medical Center of Central Georgia, Macon, GA, USA

Correspondence Address:
M S Walid
Medical Center of Central Georgia, Macon, GA
USA




How to cite this article:
Walid M S, Sanoufa M. Pathologic fracture of the odontoid as the presenting sign of metastatic cancer.Indian J Cancer 2010;47:475-475


How to cite this URL:
Walid M S, Sanoufa M. Pathologic fracture of the odontoid as the presenting sign of metastatic cancer. Indian J Cancer [serial online] 2010 [cited 2020 Jul 10 ];47:475-475
Available from: http://www.indianjcancer.com/text.asp?2010/47/4/475/73556


Full Text

Sir,

Melanoma is realistically viewed as the most aggressive form of skin cancer. In the United States, it is the sixth most common cancer diagnosis in males and the seventh in females and is primarily a disease of Caucasians (whites). [1] It is more prevalent in some other countries, such as Australia where it is ranked fourth. [2] Cutaneous melanoma can metastasize widely and in an unpredictable fashion. [3],[4] The mean survival time for a patient with skeletal metastases is 3-4 months.[5] We report a very rare case and probably the first of a patient presenting with a spontaneous pathologic fracture of the odontoid apparently from a metastasized melanoma.

A 66-year-old Caucasian nonsmoker male was sitting in his recliner when he felt a pop in his neck followed by neck stiffness and pain. Eight days later, he went to the emergency room. A radiograph of the neck was negative; so he was given pain medications and muscle relaxants and discharged home with referral to our clinic for additional evaluation. Two days later, the patient had computed tomography of the head and neck which showed a lesion involving the C2 vertebral body and dens with narrowing of the cervical canal in this segment [Figure 1]. Additional studies showed multiple hemorrhagic metastatic lesions in the cerebral and cerebellar hemispheres, and lesions in the lungs, liver, spleen, and the left adrenal gland. General physical and neurological examination was grossly negative with no major sensory or motor defects. On asking the patient about his past medical and surgical history, he mentioned a malignant melanoma removed 3 years ago. The patient was placed in a hard cervical collar and transferred to hospice care.{Figure 1}

Pathologic fracture of the odontoid should always be included in the differential diagnosis of any acute-onset neck pain with or without trauma, gross neurological defect, or frank fracture line on plain X-rays. This case demonstrates that an X-ray evaluation is not sufficient for patients with a history of cancer and complaints of sustained upper neck pain.

References

1National Cancer Institute. A Snapshot of Melanoma. Available from: http://www.cancer.gov/aboutnci/servingpeople/Melanoma-Snapshot.pdf. [last updated on 2008 Sept].
2NHMRC Melanoma Clinical Practice Guidelines 2008; pg vii. Available from: http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/cp111.pdf [last cited on 2009 Dec 22].
3King DM. Imaging of metastatic melanoma. Cancer Imaging 2006;6:204-8.
4Slattery E, O′Donoghue D. Metastatic Melanoma presenting 24 years after surgical resection: a case report and review of the literature. Cases J 2009;2:189.
5Stewart WR, Gelberman RH, Harrelson JM, Seigler HF. Skeletal metastases of melanoma. J Bone Joint Surg Am 1978;60:645-9.