title: Pain in the foot: calcaneal metastasis as the presenting feature of endometrial cancer.
abstract: BACKGROUND
  Ninety percent of endometrial cancer cases present with abnormal bleeding. Bone metastasis as the presenting feature is extremely rare.
  
  
  METHODS
  A 76-year-old woman presented with right heel pain. She had no vaginal bleeding or other symptoms suggestive of endometrial cancer. After failure of conservative therapy, imaging studies demonstrated a calcaneal metastasis. A biopsy showed adenocarcinoma. She received local radiation to her foot, with complete resolution of symptoms. Subsequent computed tomography scans showed multiple pulmonary nodules, pelvic and inguinal lymphadenopathy, and an enlarged uterus. Endometrial biopsy confirmed endometrial adenocarcinoma. She received palliative therapy and died 11 months after the diagnosis was made on the endometrial biopsy.
  
  
  CONCLUSIONS
  This case highlights the rare presentation of endometrial cancer with foot pain secondary to calcaneal metastasis. Aggressive treatment of bone metastases can provide effective palliation of symptoms.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The James Cancer Hospital and Solove Research Institute, The Ohio State University College of Medicine, Columbus, Ohio, USA. tommanolitsas@telstra.com
authors.forename: Tom P
authors.initials: TP
authors.lastname: Manolitsas
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Fowler
authors.forename: Reinhard A
authors.initials: RA
authors.lastname: Gahbauer
authors.forename: Nilendu
authors.initials: N
authors.lastname: Gupta
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000556:secondary*; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D002111:Calcaneus / Q000000981:diagnostic imaging; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D011859:Radiography