Chronic monoarthritis and previous history of cancer: think about synovial metastasis

Abstract

Synovial metastases are rare events. Only 37 cases diagnosed by synovial fluid cytologic examination and/or by microscopic investigation of synovial biopsies have been previously reported in the literature. We report another case of shoulder chronic arthritis due to a recurrence of rectal adenocarcinoma and review previous published observations. Generally, this condition carries a poor prognosis with average patients survival of less than 5 months. The possibility of metastatic disease should be considered when an elderly person or patient with a history of previous malignancy presents with a chronic arthritis.

Metastatic Renal Cell Carcinoma Presenting as Shoulder Monoarthritis: Diagnosis Based on Synovial Fluid Cytology and Immunocytochemistry

“…2 The knee is by far the most frequent joint involved. 1,3,5,7 We have been able to find 9 reported cases of metastatic shoulder arthritis. 3,8,[10][11][12][13][14] The lung is the most common site of the primary tumor, and adenocarcinoma is the most frequent histologic type.…”

“…1,3,5,7 We have been able to find 9 reported cases of metastatic shoulder arthritis. 3,8,[10][11][12][13][14] The lung is the most common site of the primary tumor, and adenocarcinoma is the most frequent histologic type. 1,[3][4][5][6][7][8][9] Renal cell carcinoma is notorious for its tendency to metastasize early, often before the primary tumor has become apparent, and then symptoms related to secondary tumor deposits can lead to the diagnosis.…”

“…Synovial metastases are rare events. It is difficult to determine the exact number of cases because the largest reviews of the literature do not include the same cases 1,[3][4][5][6][7][8][9] ; nevertheless, the most recent and largest published review known to us comprises only 39 well-documented cases. 1 Since then, 1 additional case has been described.…”

“…21 Nevertheless, the absence of malignant cells in the synovial fluid does not rule out tumor invasion, and a follow-up synovial biopsy should be performed in these cases. 1,3,7 There are 7 reported cases of synovial metastases from renal carcinoma, [12][13][14]17 4 of them sited on the shoulder joint 12,14 and none diagnosed by cytologic or immunocytochemical analysis of the joint effusion.…”

“…3,8,[10][11][12][13][14] The lung is the most common site of the primary tumor, and adenocarcinoma is the most frequent histologic type. 1,[3][4][5][6][7][8][9] Renal cell carcinoma is notorious for its tendency to metastasize early, often before the primary tumor has become apparent, and then symptoms related to secondary tumor deposits can lead to the diagnosis. 14,15 More than one third of patients with bone metastases from renal carcinoma have this as a presenting lesion of occult renal tumor, 16 and involvement of the shoulder region is not uncommon.…”