Patellar Secondaries – A Case Report.
Dr. Hydar Kunnummal, Relief Hospital, Kondotty, Kerala, India.


The skeleton is one of the commonest sites for metastasis. The incidence is probably higher than that recorded. Skeletal metastasis may present with pain localized tenderness or pathological fracture.

The present case, a 55 year old male patient presented with complaints of pain and swelling (Rt) knee following a trivial trauma. Clinically it was diagnosed as haemarthrosis.

As symptoms was not subsided patient again came with same complaints with increase effusion around the knee after 10 days. X-ray was repeated and that shows a lytic area on the anterior aspect of the patella.

On general examination detected a small soft tissue swelling over the left leg. FNAC was done; result came as spindle cell neoplasm, with advice for excision biopsy. HPR results came as Alveolar soft part sarcoma. FNAC from the lesion of the patella is suggestive of secondaries. Patient was send for nuclear study, which also shows secondaries in the patella.

Alveolar soft part sarcoma is highly malignant even though it is a slow growing tumor. Metastasis may be the first manifestation of the disease. Patient usually presented as painless mass, may misdiagnose as haematoma or pulled muscle.

Patellar metastasis is a rare presentation. There have been approximately 20 cases reported in the literature. This may present clinically as septic arthritis or meniscal injuries. Low blood flow to the patella may be the explanation why patellar secondaries are rare.

The aim of this presentation, patellar secondaries may also keep as a differential diagnosis of the knee pain.