Metastatic Esophageal Squamous Cell Carcinoma of the Femoral Head Masquerading as Brodie's Abscess with Concurrent Methicillin-Resistant Staphylococcus aureus Infection: A Diagnostic Dilemma.
- 1Department of Orthopaedics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
- 2Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
Abstract
Brodie's abscess is a localized form of subacute osteomyelitis that usually presents as a well-defined lytic lesion with surrounding sclerosis and characteristic peripheral rim enhancement on magnetic resonance imaging (MRI). However, these imaging features are not specific and may also be seen in malignant bone lesions, creating a significant diagnostic challenge. The coexistence of infection and malignancy within the same lesion is extremely uncommon and can further complicate diagnosis. We report a rare case of metastatic esophageal squamous cell carcinoma (ESCC) involving the femoral head that clinically and radiologically mimicked Brodie's abscess in the presence of concurrent methicillin-resistant Staphylococcus aureus (MRSA) infection. A 53-year-old man with a long history of smoking presented with progressively worsening pain in the right groin and difficulty walking for 2 months. Laboratory investigations showed elevated inflammatory markers, and MRI demonstrated a rim-enhancing lesion in the femoral head with surrounding marrow edema, raising a strong suspicion of Brodie's abscess. The patient underwent core decompression, during which friable grey-white tissue was encountered instead of the expected purulent material. Intraoperative cultures grew MRSA, initially supporting the diagnosis of subacute osteomyelitis. However, histopathological examination revealed metastatic squamous cell carcinoma. Further evaluation with upper gastrointestinal endoscopy confirmed a moderately differentiated squamous cell carcinoma of the mid-esophagus, establishing the femoral lesion as a metastatic deposit with superimposed MRSA infection. This case highlights the importance of maintaining a broad differential diagnosis when evaluating atypical bone lesions. Imaging findings and positive microbiological cultures alone may be misleading, particularly in patients with risk factors for malignancy. Histopathological examination remains the definitive diagnostic tool and should be obtained whenever there is diagnostic uncertainty, as early tissue diagnosis is essential for timely and appropriate management.
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BibTeX
@article{sharma2026metastatic,
title = {{Metastatic Esophageal Squamous Cell Carcinoma of the Femoral Head Masquerading as Brodie's Abscess with Concurrent Methicillin-Resistant Staphylococcus aureus Infection: A Diagnostic Dilemma.}},
author = {Chirag Sharma and Naman Modi and Bhaskar Borgohain and Tashi G Khonglah and Alokananda Mandal},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8476},
url = {https://europepmc.org/article/MED/42997152},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Metastatic Esophageal Squamous Cell Carcinoma of the Femoral Head Masquerading as Brodie's Abscess with Concurrent Methicillin-Resistant Staphylococcus aureus Infection: A Diagnostic Dilemma.
AU - Chirag Sharma
AU - Naman Modi
AU - Bhaskar Borgohain
AU - Tashi G Khonglah
AU - Alokananda Mandal
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8476
UR - https://europepmc.org/article/MED/42997152
AB - Brodie's abscess is a localized form of subacute osteomyelitis that usually presents as a well-defined lytic lesion with surrounding sclerosis and characteristic peripheral rim enhancement on magnetic resonance imaging (MRI). However, these imaging features are not specific and may also be seen in malignant bone lesions, creating a significant diagnostic challenge. The coexistence of infection and malignancy within the same lesion is extremely uncommon and can further complicate diagnosis. We report a rare case of metastatic esophageal squamous cell carcinoma (ESCC) involving the femoral head that clinically and radiologically mimicked Brodie's abscess in the presence of concurrent methicillin-resistant Staphylococcus aureus (MRSA) infection. A 53-year-old man with a long history of smoking presented with progressively worsening pain in the right groin and difficulty walking for 2 months. Laboratory investigations showed elevated inflammatory markers, and MRI demonstrated a rim-enhancing lesion in the femoral head with surrounding marrow edema, raising a strong suspicion of Brodie's abscess. The patient underwent core decompression, during which friable grey-white tissue was encountered instead of the expected purulent material. Intraoperative cultures grew MRSA, initially supporting the diagnosis of subacute osteomyelitis. However, histopathological examination revealed metastatic squamous cell carcinoma. Further evaluation with upper gastrointestinal endoscopy confirmed a moderately differentiated squamous cell carcinoma of the mid-esophagus, establishing the femoral lesion as a metastatic deposit with superimposed MRSA infection. This case highlights the importance of maintaining a broad differential diagnosis when evaluating atypical bone lesions. Imaging findings and positive microbiological cultures alone may be misleading, particularly in patients with risk factors for malignancy. Histopathological examination remains the definitive diagnostic tool and should be obtained whenever there is diagnostic uncertainty, as early tissue diagnosis is essential for timely and appropriate management.
SN - 2250-0685
SN - 2321-3817
ER -