Femoral Adamantinoma: A Rare Lesion in an Elderly Patient in a Rare Location

To the Editor, Adamantinoma is a low-grade, extremely rare primary malignant bone tumour suggested to be of epithelial lineage. These tumours commonly present at between 10 and 50 years of age and have a propensity for presentation in the tibia (approximately 90% cases), although they have been reported in various other bones (1). A 76-year-old male patient was referred to our unit from another hospital for further management of persistent pain in the femur following locked intramedullary nailing for a lytic lesion in his right femur (Figure 1). This patient presented to the primary hospital with a 2-year history of thigh and knee pain. He was managed by a general orthopaedic surgeon, who after history and examination performed a biopsy and locked intramedullary nailing simultaneously, assuming this to be a metastatic deposit, considering his age and a impending fracture. Histology was reported at the primary hospital to be consistent with metastatic adenocarcinoma from prostate as the patient was also having treatment for prostate carcinoma. He persisted with pain in the thigh and knee 6 months following surgical management of his prostate cancer and femoral lesion and was referred to us for opinion and management. As the patient had persistent pain, we performed a ‘metastatectomy and cementation’ of this lesion and also arranged for adjuvant radiotherapy, assuming that the whole femur was contaminated. Samples from surgery performed were reported as adamanatinoma of the bone and this was later found 1Department of Orthopaedics, Selçuk University School of Medicine, Konya, Turkey 2Clinic of Oncology, Royal Orthopaedic Hospital, Birmingham, United Kingdom 3Department of Orthopaedics and Traumatology, Rehman Medical Institute, Peshawar, Pakistan 4Department of Orthopaedics, ISOM Medical Center, İstanbul, Turkey 5Department of Pathology, Selçuk University School of Medicine, Konya, Turkey Bahattin Kerem Aydın1, Zeeshan Khan2,3, Turgay Er4, Serdar Uğraş5