Search

A 75-year-old lady was referred to the oral and maxillofacial surgery (OMFS) team with a painless swelling in the midline of her forehead. Investigations diagnosed it as a solitary metastasis of thyroid cancer. Follicular thyroid cancers are known to metastasise to bone; however, bony metastasis to the frontal bone of the skull is very rare. This case highlights how the effective use of a multidisciplinary team can lead to better patient outcomes. The patient went on to have a total thyroidectomy and received both radioactive iodine therapy and radiotherapy to the bony metastasis.

Objective: With new evidence showing no need to perform staging bone scans (BS) in intermediate-risk prostate cancer (PC), we reviewed the practice and trends of performing BS in PC patients across the United Kingdom by analysing a cohort of PC patients from the British Association of Urological Surgeons (BAUS) radical prostatectomy (RP) database. We analysed the database as such for data entry and regional trends. Materials and methods: Between 2007 and 2016, patients who had BS were categorised according to D’Amico risk categories as low (LR), intermediate (IR) and high (HR). The IR group was subdivided into primary patterns 3 (IR3) and 4 (IR4). Subgroup analysis based on prostate-specific antigen and Gleason score was performed. Regional trends regarding data entry and no staging scans before RP were also analysed. Results: Over the study period, the database included 39,382 patients. The quality of data improved from 2011. A consistent drop in proportion of LR patients who had BS was noted over the study period which stood at less than 1% in 2016. This parallels an increase in proportion of HR patients, but the IR3 and IR4 proportion remained stable throughout the study. A large proportion of HR patients were deemed HR because of clinical T stage in the subgroup analysis. A progressive drop is noted in patients having no scan before RP, which stood at 3.66% in 2016. Out of 15 regions, 13 showed improvement in data completeness. Conclusion: In the United Kingdom, good adherence with guidelines to avoid BS in LR patients is noted but is still continued in IR. Updating the guidelines which are still not uniform and involvement of specialist multidisciplinary teams to reflect these would help reduce a considerable number of unnecessary BS being performed. Regional trends shown would help relevant centres to review their data entry process and potentially improve them. Level of evidence: not applicable for this multicentre audit.

Cancer prevalence is increasing over the past few decades. Spinal osseous metastasis is one of the most common sites of secondary neoplastic disease among cancer patients [1]. Spinal malignancies can broadly be classified into primary spinal cancers and secondary spinal metastasis. Metastatic spinal cancers are more common than primary malignancy of the spine. Metastatic spinal cancers are further subdivided into two parts based on the involvement of the dura mater; metastasis external to dura mater can be termed as metastatic epidural spinal cancers (MESC); metastasis inside the dura mater is called metastatic intradural spinal cancers (MISC) [2]. Bony involvements of vertebrae are common at the presentation of MESC while the involvement of the spinal cord and meninges is a prominent feature of MISC. However, the clinical presentation is quite overlapping and timely-decision making is quite challenging in several cases. Several grading systems have been developed to assess the severity of spinal cancers [3-6]. Such ambiguities require a need for teamwork between different specialties to decide the management plan for better patient care. Multidisciplinary Tumor Boards (MDT) are the practical venue where different specialists are present for the discussion [7].

Fine needle aspiration cytology is cheap, non invasive and time saving procedure in diagnosis and management of patients in developing countries. Metastasis of renal cell carcinoma (RCC) to distant sites and organs at time of presentation is not infrequently encountered in the setting of FNAC for initial diagnosis. Here, we present a case of metastatic RCC to right clavicle initially diagnosed on FNAC and was confirmed on radiological examination of abdomen and histopathological examination. DOI: 10.21276/APALM.1121

During 2012-13, we diagnosed 4 patients with extensive skeletal tuberculosis (TB) who were referred to us as cases of bony metastasis with unknown primary. Radiological investigations done outside favoured a diagnosis of disseminated malignancy. Positron emission tomography/computed tomography (PET/CT) scan performed in our institute for localization of primary lesion also suggested metastatic disease. There was no evidence of malignancy on histo-pathological examination (HPE) of the involved sites. The diagnosis of TB was established on characteristics HPE. This article highlights the diagnostic dilemma of PET/CT in cases of TB versus malignancy and the importance of HPE for reaching an accurate diagnosis.

Carcinoma of the oesophagus metastasizes to distant sites in approximately one third of cases and rarely involves the upper limb bones. We describe three such rare cases of isolated metastasis to upper limb bone from oesophageal cancer.

Vertebral haemangiomas (VHs) are benign vascular lesions of vertebral bodies, and are common incidental findings in imaging, occurring in approximately 10–12% of the adult population.1 These lesions consist of thin-walled blood vessels that pervade the medul-lary cavity between trabecula.2 Typically, VHs are asymptomatic and do not require intervention unless causing neurological compromise.

The aim of this study was to evaluate the role of single photon emission computed tomography and/or computed tomography (SPECT/CT) in differentiating metastatic from benign solitary skull lesions.Consecutive patients who had a SPECT/CT of the head subsequent to a whole-body bone scan (WBS) for the evaluation of a single skull lesion were selected. A single skull lesion on the WBS was further evaluated with SPECT/CT to characterize the lesion. The results of the SPECT/CT were correlated with other radiologic examinations performed within 2 weeks. An average follow-up interval after the SPECT/CT was 8.9 months to correlate with additional radiologic imaging studies and clinical information.A total of 19 lesions in 19 patients were seen on the WBS and 2 additional lesions on the SPECT/CT. All lesions demonstrated focal increased tracer uptake. The SPECT/CT correctly identified 3 out of 3 metastatic lesions and 12 out of 17 benign lesions, that is 71% of lesions were correctly classifised as metastatic or benign lesions. Only 1 patient was classified incorrectly as metastatic lesion with SPECT/CT when it was proven benign by other imaging modalities and follow-up. The sensitivity, specificity, positive and negative predictive values of SPECT/CT images in identifying metastatic lesions were 100%, 92%, 75%, and 100%, respectively. Five lesions remained indeterminate even after the SPECT/CT interpretation and were confirmed benign by other imaging modalities.SPECT/CT can help identify benign versus metastatic solitary skull lesions in most of the patients with high sensitivity and specificity.

A 32-month-old female child with a history of stage IV favorable biology neuroblastoma with a 123-I MIBG (metaiodobenzylguanidine scan) avid adrenal mass, with retroperitoneal nodal extension and bony metastasis, was in complete remission after intense multimodal therapy. Seventeen months after diagnosis a surveillance 123-I MIBG scan showed abnormal tracer uptake in the midzone of the right thorax. Chest x-ray and CT scan confirmed right upper lobe consolidation corresponding to the tracer uptake. Chest x-ray after antibiotics showed resolution of the abnormality. 123-I MIBG scan 3 months later showed no abnormal uptake. False-positive MIBG uptake in pneumonia has not been previously reported.

Current nuclear imaging of the skeletal system is achieved using technetium-99m (Tc-99m) methylene diphosphonate (MDP), F-18 sodium fluoride (NaF), or F-18 fluorodeoxyglucose (FDG). However, comparisons of these are rare in the literature. We present a case of a 51-year-old female with suspicious lung cancer due to main symptoms of dyspnea, nonproductive cough, and pleural pain. Tc-99m MDP whole-body bone scan (WBBS) showed multiple bony metastases. Five days later, positron emission tomography/computed tomography (PET/CT) images using both F-18 NaF and a cocktail of F-18 NaF and F-18 FDG were obtained on the same day 2 hours apart. The former showed more foci and precisely showed bony lesions compared to those obtained using Tc-99m MDP WBBS. However, the latter demonstrated more extensive radiotracer uptake, especially in osteolytic lesions, and additional soft tissue lesions in the left axillary and surpraclavicular nodes as well as the left pleura. Surgical biopsy was performed in left axillary nodes, and the metastatic carcinoma was found to be of breast origin. This case demonstrated that a cocktail of F-18 NaF and F-18 FDG could be useful in PET/CT for not only detecting more skeletal lesions but also guiding biopsies accurately to the affected tissue.

The optimal timing of I-123 MIBG scintigraphy in the evaluation of pheochromocytoma is unknown. Although some centers perform early imaging, many delay imaging until 24 hours after injection. The authors describe the case of a bony metastasis in the left femur that was detected 5 hours after injection, but which was not visualized at 24 hours.

e11122 Background: Bone metastasis is the most common site of metastases from breast cancer. Bone scan using technetium-99m is widely used for the detection of bony metastasis in patients with brea...

Periosteal osteosarcoma is a rare variant of osteosarcoma and has represented 1-2% of all osteosarcomas. Most local recurrences or progression to metastatic disease occurred within the first 3 years after presentation and lung metastasis is more common than bony metastasis. We describe a periosteal osteosarcoma of tibia patient who developed conventional osteosarcoma of proximal humerus after 13 years from the completion of treatment.

Neuroendocrine tumours- their rare occurrence and propensity for recurrences can undoubtedly pose as a diagnostic and therapeutic dilemma. A case report of one such case with recurrence and bony metastasis is presented.

A case of bony metastasis from carcinoma of the body of uterus is presented, hitherto unreported. Diagnosis was difficult in this very unusual presentation, but the importance of post-menopausal bleeding must be emphasized.

Bone scanning is a sensitive test for the detection of metastatic breast cancer, but not all abnormal findings on bone scan are diagnostic of skeletal metastasis. Recent studies have found a relatively low rate (less than or equal to 5%) of abnormal scans in patients with Stage I and II breast cancers, and only half of those with positive scans subsequently had documented bony metastasis. The overwhelming clinical experiences summarized here question the value of including bone scanning as part of the routine work-up of patients with early breast cancers.

The preoperative evaluation of extremity sarcomas is necessary to give the surgical oncologist the information necessary to surgically stage the lesion to plan his surgical procedure. Flow cytometry, tumor markers, etc. will not be discussed, rather, the rationale for surgical preoperative evaluation.

n/a

Bone hemangiomas are rare benign tumors of the bones of vascular origin. A patient with bony pains and abnormalradiological findings is described. Following an unsuccessful extensive search for primary malignancy the patient wasdiagnosed as multiple bone hemangioma. This case serves as a reminder for considering benign causes of bonelesion while investigating cases with such presentation.Keywords: Hemangioma; multiple; sclerosing hemangioma; back painDOI: 10.3329/jom.v11i2.5473J MEDICINE 2010; 11 : 196-199

A case of solitary distant bony metastasis from carcinoma of laryngopharynx in a 55 year old female patient is reported. Literature is reviewed in brief.