![]() ![]() On further review of history, she had been diagnosed with carcinoma of the left breast 7 years earlier, for which she had wide local excision followed by chemotherapy and radiotherapy. She presented 3 weeks later with increasing intensity of pain. Following clinical examination, radiographs of the cervical spine were normal. Treatment is palliative to relieve pain, prevent pathological fracture, improve mobility and function, and prolong survival.Ī 40-year-old woman presented to the accident and emergency department with neck and shoulder pain of 1 week duration with no radiation and neurological deficit. Prompt treatment can relieve symptoms and avoid late sequelae therefore the recognition of this potentially lethal complication is of prime importance. The clinical findings lag behind the radiographic abnormalities. Odontoid fractures in patients with metastatic carcinoma of the breast are rare. Although the incidence of skeletal metastasis in breast carcinoma is 30% with the possibility of prolonged survival, little importance has been given to metastasis of the odontoid process. Patients with cervical metastasis have a higher mortality due to advanced stage of the malignancy. Thirty percent of cervical spine metastasis had a primary breast malignancy. To recognise spinal metastasis radiographically, 30–50% of the vertebral body must be involved. This spinal metastasis can be osteosclerotic or osteolytic. The occurrence of cervical spine metastasis is less common than thoracic or lumbar spine metastasis. Spine is the most common site of bone metastasis. Metastatic lesions of the odontoid are atypical, and this case reinforces the necessity of early detection to evade disastrous consequences. She underwent cyclical radiotherapy with complete resolution of the odontoid peg lesion and clinically was asymptomatic at 2 years. Further investigation including magnetic resonance imaging and bone scan showed no further spinal lesions. Radiographs repeated 3 weeks later revealed a large lytic lesion of the odontoid occupying 70–80% of the peg. Following clinical examination, radiographs taken of the cervical spine was normal. We describe a 40-year-old woman with a history of breast cancer who presented with neck and shoulder pain of 1 week duration with no neurological deficit. Treatment is palliative to relieve pain, prevent pathological fracture, improve mobility and function, and prolong survival. Patients with cervical metastasis have higher mortality due to advanced stage of the malignancy. Nearly one third of cervical spine metastasis has a primary breast malignancy. ![]()
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