Search

Renal Cell Carcinoma (RCC) accounts for 5% of the epithelial malignancies worldwide with clear cell carcinoma accounting for 85% of these malignancies. One third of these patients experience synchronous metastatic disease and 20-30% of the remaining patients experience metachronous metastatic RCC. Bony metastasis accounts for 20% of metastatic RCC. They most commonly affect the axial skeleton and rarely the long bones or the small bones of the hands and feet. Bone metastases from RCC are predominantly osteolytic in nature, leading to significant patient morbidity due to the associated Skeletal Related Events (SRE). SREs may significantly decrease patient quality of life. Bone pain is most common SRE and radiotherapy is most common form of treatment. Only 2% of the patients require surgery. Here we present a case of advanced RCC with tibial and ankle metastasis who presented to us after one year of radical nephrectomy with severe pain and inability to walk and underwent above knee amputation.

Cancer drug development generally performs in vivo evaluation of treatment effects that have traditionally relied on detection of morphologic changes. The emergence of new targeted therapies, which may not result in gross morphologic changes, has spurred investigation into more specific imaging methods to quantify response, such as targeted fluorescent probes and bioluminescent cells. The present study investigated tissue response to docetaxel or zoledronic acid (ZA) in a mouse model of bony metastasis. Intratibial implantations of breast cancer cells (MDA-MB-231) were monitored throughout this study using several modalities: molecular resonance imaging (MRI) tumor volume and apparent diffusion coefficient (ADC), micro-computed tomography (µCT) bone volume, bioluminescence imaging (BLI) reporting cancer cell apoptosis, and fluorescence using Osteosense 800 and CatK 680-FAST. Docetaxel treatment resulted in tumor cell kill reflected by ADC and BLI increases and tumor volume reduction, with delayed bone recovery seen in µCT prefaced by increased osteoblastic activity (Osteosense 800). In contrast, the ZA treatment group produced similar values in MRI, BLI, and Osteosense 800 fluorescence imaging readouts when compared to controls. However, µCT bone volume increased significantly by the first week post-treatment and the CatK 680-FAST signal was slightly diminished by 4 weeks following ZA treatment. Multimodality imaging provides a more comprehensive tool for new drug evaluation and efficacy screening through identification of morphology as well as function and apoptotic signaling.

Background Spinal metastasis is a common manifestation of bony metastasis, but for surgeons involved in the treatment of individual patients, it is not easy to choose optimal treatments. Various scoring systems have been designed to predict survival periods and to select optimal treatments, but prognosis is still unpredictable. Objectives are to evaluate the efficiency of the predictive value of preoperative Tokuhashi scores for life expectancy in patients with spinal metastasis and to estimate other prognostic factors affected survival of patients with spinal metastasis.

A majority of patients with castrate-resistant prostate cancer ultimately develop distant metastases, with bone being the most common site of spread. Classically, systemic therapy has been considered the standard of care for patients with metastatic cancer. Emerging evidence, however, suggests that an intermediate oligometastatic state, between limited disease and widespread metastases, exists; theoretically, with locally ablative treatment, patients may be curable. We describe a complete PSA response following aggressive management, using stereotactic body radiotherapy (SBRT), of an oligometastatic spine lesion in the setting of castrate-resistant prostate cancer (CRPC). This case report supports the use of SBRT in oligometastatic CRPC and suggests that management of limited metastases may provide good long-term outcomes in well-selected patients.

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.

The role of nuclear medicine diagnostic bone scanning is well established in prostate cancer. This case provides an insight into the specific role that bone scanning plays in monitoring response to hormone therapy and an example of significant global skeletal response. The case highlights the remarkable efficacy of timely hormone therapy in high-grade prostate cancer with widespread bony metastasis. In addition, the range of hormone therapy currently available for clinical application in the management of metastatic prostate cancer is detailed. Finally, the case represents an incidental diagnosis of prostate cancer after evaluation of nonspecific symptoms.

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.

We carried out excision of a solitary bony metastasis from renal-cell carcinoma in 25 patients in the hope that this would produce a prolonged disease-free interval. Two patients had excisions only, five had amputations and 18 had excision and endoprosthetic replacement. The one-, three- and five-year cumulative survival rates were 88%, 54% and 13%, respectively. There were three complications. One patient developed a local recurrence and three had problems related to the endoprosthesis. We recommend radical excision of a solitary bony metastasis from renal-cell carcinoma to achieve local control of the tumour for the remainder of the patient’s life.

Hepatocellular carcinoma (HCC) is one of the most common malignancies of the world and about 30-50% cases of HCC have extra hepatic metastases. 1 Bone is considered to be an uncommon site for metastasis in HCC. We report a case of HCC with secondaries in the body of sternum. Review of literature also shows that bone is not that uncommon site for metastases in HCC and HCC should be considered in the differential diagnosis of patients with bony metastases.

Granulosa cell tumour is among the rarest forms of testicular cancer. Only 21 cases have been reported to date and only 4 have metastasised. All documented metastases are intra-abdominal. We present the first case of granulosa cell tumour of the testis metastasising to bone (tibia), presenting 6 years after orchidectomy. This highlights the need to maintain a high index of suspicion for extra-abdominal metastases during long-term follow-up in patients with previous testicular granulosa cell tumour.

Adenoid cystic carcinoma is a fairly uncommon salivary neoplasm of the head and neck. These lesions often progress insidiously, and they have a propensity for early perineural spread and bony invasion. Distant metastasis to the lungs is fairly common and is usually fatal. We report a rare case of adenoid cystic carcinoma in a patient who on initial evaluation had widespread bony metastasis but no pulmonary involvement.

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.

Since the late 1960s, air-fluidized therapy (AFT) has been effectively used to treat patients with pressure ulcers, burns, and many other clinical problems. Much of the demonstrated efficacy is believed to be associated with the unique fluid environment provided by AFT that is fundamentally different from the support provided by surfaces made up of conventional solid materials. Fluid support maximizes the envelopment of the body while significantly reducing shear, friction, and pressure, and mechanical stress applied to the skin and subcutaneous tissue. Additionally, the variable temperature airflow allows the microclimate to be controlled according to needs for both therapy and patient comfort. Clinical benefits of AFT include faster and more cost-effective healing of pressure ulcers, a decreased rate of hospitalizations and emergency room visits for long-term care pressure ulcer patients, decreased mortality of patients with extensive burns and inhalation injury and rapid healing and increased comfort in burn patients. The fluid support also results in a substantial decrease in the amount of caregiver effort required for repositioning patients and increased patient comfort in patients with multiple trauma and external fixation devices or deformities that require a conforming bed, and patients with cancer and bony metastasis. This article seeks to evaluate the physical differences in AFT over other mattress types and to review the published literature for this therapy modality.

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.

Presentation of colonic adenocarcinoma with bony metastasis is rare and associated with a poor prognosis.

Osseous metastasis from a primary breast cancer is common, and the skeletal related morbidity is high. However, solitary acral bony metastasis is rare and the diagnosis of these lesions poses a challenge to the physician. We describe a case of a patient treated with primary breast cancer who later presented with metastatic osteolytic bone lesions confined to a forefinger and toe.

A 72 year old woman presented with left hip pain. Computed tomography showed bony metastasis of the femoral neck⇑. There …

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.

Se presenta un caso de leiomiosarcoma de escroto en un paciente de 87 años que debuta como una lesión en hemiescroto izquierdo indolora, y de un año de evolución. En el momento del diagnóstico se observa la presencia de metástasis óseas. Se realiza una revisión de la literatura comprobándose la rareza de este tipo de lesión (sólo se han descrito 27 casos), y que a diferencia de otro tipo de leiomiosarcomas, su evolución agresiva no es habitual en esta localización. A case of scrotum leiomyosarcoma is presented in a 87 year-old patient. It debuts as a painless lesion in left hemiescrotum, of one year of evolution. Bony metástasis were observed in the moment of the diagnosis. We carried out a literature revision proving the rarity of this lesion type (only 27 cases have been described), and that, contrary to another leiomiosarcomas type, their aggressive evolution is not habitual in this localization.

In France, kidney cancer represents 2.1% to 2.6% of cancers in adults with a higher frequency between 50 and 70 years of age and male predominance. It causes 2% of cancer mortality.

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...

Background: Paragangliomas are tumors of neural crest origin that arise from the extra-adrenal paraganglia. In contrast with the often quoted 10% rule of malignancy for pheochromocytomas, the rate of malignancy as defined by local invasion or distant metastasis has been reported to be from 20% to as high as 50% in some case series with the most common sites of distant metastases being the liver, lungs, and bones. Here we present the case of a patient who presented with a rare case of intracranial metastasis from abdominal paraganglioma. Case Description: Our patient was a 48-year-old male with a distant history of multiple resections of abdominal paraganglioma in 1975 who presented with left shoulder, and left occipital metastasis 35 years after his original paraganglioma operations. Conclusions: Intracranial metastasis of paraganglioma is rare. There are unfortunately no known criteria to assess the risk of metastatic potential and given the long possible latency period between the resection of the primary tumor and the discovery of metastatic disease, patients with paragangliomas require lifelong monitoring. The optimal interval of monitoring has not been elucidated but follow-up every 5–10 years seems warranted.

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.

Hepatocellular carcinoma (HCC) presenting initially as a bony metastasis is rare. Involvement of maxillofacial bones is even more rare and only 20 cases have been reported. A case of a 65-year-old male patient presenting with metastasis to the mandible from a primary HCC is described.

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.

9074 Background: Intravenous bisphosphonate therapy has been used for treatment of various benign and malignant bone diseases, including bony metastasis. Recent single case reports have described osteonecrosis (ON) of the mandible or maxilla as a previously unknown complication of this therapy. Methods: Records of 638 patients treated with intravenous pamidronate or zoledronic acid were reviewed to determine the incidence of jaw ON. Number of infusions, dosing interval, dosage administered, and duration of treatment were analyzed to determine risk factors for the development of this complication. Results: Mean age of the study group was 67 years and 61% were female. The most common primary malignancies included prostate, lung, breast, and multiple myeloma. The overall incidence of osteonecrosis was 6/638 (0.94%). Patients treated with pamidronate (n=336), zoledronic acid (n=169), and both agents (n=133) had an incidence of ON of 1.2%, 0%, and 1.5% respectively (p=NS). No significant relationship was observed between the incidence of ON and demographic parameters, primary tumor, cumulative drug dose, or dosing interval. However, patients who developed ON had a significantly greater mean number of infusions (20.7 versus 10.7, p=0.016) and significantly greater mean hours of infusion time (42.7 versus 17.7, p=0.0036) than those who did not develop the complication. Underlying dental disease appears to be associated with ON. Conclusions: This review represents the largest single series to date of patients treated with IV bisphosphonate therapy. The findings suggest positive correlation between the development of ON and drug exposure as measured by number of infusions and total infusion hours. However, this data must be interpreted with caution as the overall incidence of the complication was low ( No significant financial relationships to disclose.

8002 Background: Pain control in bony metastasis in malignancies is an important aspect of cancer care. More than 60% of patients with advanced malignancies have significant pain, associated severe...

最近の28年間に慈恵医大および関連病院で経験された, 骨に転移を認めた腎細胞癌症例59例(骨のみ転移例は17例)について, 臨床的特徴を検討するため, 肺転移症例146例(肺のみ転移例は54例)を比較対照として検討した.すなわち, 骨転移部位としては, 下肢が最も多く32.6%を占め, ついで脊椎, 上肢, 骨盤, 次に肩甲帯, 胸郭, 頭蓋骨の順となっていた.骨のみ転移例と, 肺のみ転移例の生存率を比較すると, 3年以後7年まで, 骨のみ転移例が転帰良好であった.また, 単発転移と多発転移に分けて両者を比較すると, 単発骨転移2例(すべて手術的切除例)の予後が良好であった.原発のgrade別に骨のみ転移例と, 肺のみ転移例の生存率を比較したが, 骨のみ転移例では両grade (low gradeとhigh grade)症例間に有意差はなかった.一方, 肺転移ではlow gradeの症例がhigh gradeの症例に比し有意に予後良好であった.従って骨転移については, 原発巣の悪性度は肺転移例のそれに比して予後に大きな影響を及ぼさないものと考えられた, For the purpose of clinical analysis of renal cell carcinoma with bony metastasis (59 cases) the cases with lung metastasis (146 cases) were selected for comparison. The analyzed items were the distribution of bony metastatic portions, the results of radiotherapy for bony metastasis, comparative study with lung metastasis on clinical background, comparative study with lung and bony metastasis on the survival rate, comparative study with solitary bony and lung metastasis on the survival rate, comparative study with bony and lung metastasis on the grade of primary lesion. The most frequent metastatic portion was lower extremities, spine, upper extremities and pelvic bone in this order. The survival rate of the cases with bony metastasis was better than that of lung, especially with solitary metastatic cases. The effects of radiotherapy for bony metastasis were not so good for prolonging the survival. The grade of kidney malignancy did not influence the survival of patients with bony metastasis, on the contrary, in patients with lung metastasis, there was a good prognostic factor for survival.

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.

Summary Stress fracture is a rarely reported late complication of radical neck dissection. The condition should be recognised as its clinical and radiological differentiation from avascular necrosis or bony metastasis may be difficult.

A case of hypercalcemia associated with documented squamous cell carcinoma of the renal pelvis without bony metastasis is reported. Pseudohyperparathyroidism was suspected strongly because of the radioimmunoassay values of parathormone. This was confirmed by the prompt decrease of serum calcium after removal of the neoplasm. The radiologic findings were nonspecific.

The precise incidence of metastatic involvement of bone in carcinoma of the uterine cervix is unknown. The reported total incidence varies in different studies but tends to be low. In the author's experience bony metastasis occurs more frequently than is generally recognised. In this study all the cases of cervical cancer treated in one hospital over a period of two consecutive years have been analysed In this respect. Bone secondaries were discovered in 16%. The possible factors influencing secondary spread to bone are discussed, and of these the degree of histological differentiation was found to be the most important.

Secondary tumors in the hand are very uncommon. Of the reported cases the majority arise from primary bronchial carcinoma, with multiple secondary deposits into bone. A case is reported of bony metastasis to the middle phalanx of the small finger in a patient who had a resection of a colonic adenocarcinoma 2 years previously.