# Pancreatic Adenocarcinoma Presenting as a Pathologic Femoral Fracture: A Rare Initial Manifestation

## TL;DR

A rare case of pancreatic cancer presenting as a bone fracture highlights the need for considering hidden cancers in unusual injuries.

## Contribution

This case report highlights the rare initial presentation of pancreatic adenocarcinoma as a pathologic femoral fracture.

## Key findings

- Pancreatic tail cancer can present atypically with a pathologic femoral fracture.
- Bone metastasis from pancreatic adenocarcinoma is uncommon but should be considered in atypical fractures.
- Early recognition of such presentations can improve multidisciplinary cancer management.

## Abstract

Pancreatic tail cancers often manifest with vague, nonspecific symptoms, contributing to delayed diagnosis. Bone metastasis from pancreatic adenocarcinoma is uncommon, and presentation with a pathologic fracture is especially atypical. We present the case of a 62-year-old man with obesity, long-standing tobacco use, and regular alcohol consumption who developed an atraumatic femoral fracture. Imaging revealed a destructive lytic lesion in the femur and a pancreatic tail mass with pulmonary nodules. Endoscopic ultrasound-guided fine-needle aspiration biopsy established the diagnosis of pancreatic adenocarcinoma. The patient had an open reduction fixation by orthopedic surgery followed by oncology referral for systemic therapy. This case underscores the importance of considering occult malignancy in atypical fractures and highlights that gastrointestinal malignancies, though infrequent, can metastasize to bone. Early recognition may facilitate prompt diagnosis and improve multidisciplinary management.