Pubic bone metastasis as first manifestation of lung cancer

Background. Pubic bone metastasis as the initial manifestation of lung cancer is very rare, and it may simulate parasymphyseal insufficiency fracture of the pubic bone, which is observed in postmenopausal women and elderly people. Case report. A 65-year-old woman developed pain in the right flank, which extended to the anterior aspect of the thigh. A pelvic X-ray showed osteolytic lesion in the right pubic ramus. Chest radiograph revealed a nodular mass in the right middle lobe of the lung. Transbronchal biopsy of the mass led to the diagnosis of lung adenocarcinoma. The patient was given radiotherapy of osteolytic lesion in her right pubic ramus and the pain was controlled with a combination of morphine sulfate. Conclusions. When unusual bone metastasis is found in the absence of a primary tumor, investigation must include chest radiographs.