Vol 12 ppt
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This document discusses numerous cases of patients presenting with bone lesions that were initially suspected to be metastatic disease but were later determined to be other diagnoses. Case 1169 describes a 47-year-old female whose stress fracture of the femoral neck was mistaken for a metastatic lesion. Imaging and biopsy revealed the lesion was actually a pseudotumor caused by osteoporosis. Similarly, Case 1169.1 involves a 43-year-old female on steroids whose bilateral hip pain was from stress fractures, not metastases as indicated on her bone scan. The document emphasizes that various benign bone conditions can resemble metastatic bone cancer on imaging and biopsy is often needed for accurate diagnosis.
Vol 12 ppt
- 1. Volume 12 Metastatic carcinoma----------Case 1122-1169
- 2. Case #1122 54 year male with prior history of metastatic renal cell CA to proximal femur with DHS & cement fixation and post op radiation therapy
- 3. One year later with recurrent tumor
- 4. Surgical specimen tumor following wide resection bulge proximal femur
- 5. Photomic
- 6. Autoclaved prox femur placed over long stem femoral component
- 7. cement Cemented back in normal anatomic position with THA osteotomy
- 8. 5 months post op with radiolucent cement
- 9. 18 months post op
- 10. Case #1124 58 year male with metastatic renal cell CA to pelvis
- 11. Post op treatment with radiolucent cement THA and radiation therapy
- 12. Case #1125 65 year male with path fracture thru metastatic renal cell CA in sciatic notch area
- 13. Case #1126 48 year male with large hemorrhagic renal cell CA distal humerus tumor
- 14. Case #1127 66 year male with metastatic renal cell CA post op ORIF, pin fixation and post op RT
- 15. Case #1128 61 year female with metastatic renal cell CA hip area
- 16. Lytic lesion in clavicle
- 17. Metastatic Renal Cell Multiple lesions in both hands
- 18. Case #1128.1 57 year male with renal cell CA metastasis to fibular
- 19. 6 months later without treatment
- 20. Bone scan
- 21. Sagittal T-2 MRI
- 22. Photomic
- 23. Case #1129 61 year female with metastatic aneurysmal renal cell CA to distal tibia
- 24. Photomic
- 25. Case #1130 Metastatic Renal Cell 45 year male with metastatic renal cell CA to os calcis
- 26. Sagital T-1 MRI
- 28. Axal T-1 MRI
- 29. Axial T-2 MRI
- 30. Photomic
- 31. Case #1131 54 year female with metastatic aneurysmal thyroid to pelvis
- 32. CT scan
- 33. Case #1132 45 year female with lytic thyroid metastasis to pelvis
- 34. tumor tumor Rapid progression without treatment 6 months later
- 35. Case #1133 MetastaticThyroid 52 year female with metastatic thyroid CA to pelvis
- 36. Case #1134 54 year female with metastatic thyroid CA to pelvis
- 37. Case #1135 48 yr male with metastatic blastic thyroid met to femoral neck
- 38. Bone scan
- 39. Case #1135.1 21 year female with large pelvic mass which turned out to be a metastatic thyroid metastasis from an ovarian teratoma
- 40. Pelvic metastasis seen on PO x-ray following teratoma surgery
- 41. tumor Bone scan
- 44. I-131 isotope scan prior to teratoma surgery shows uptake in both the ovarian teratoma and pelvic met
- 45. Surgical specimen from resection of pelvic metastasis
- 46. Photomic from thyroid metastasis
- 47. Placement of multiple Steinman pins prior to cementation
- 48. Bone cement placed over pins
- 49. Post op reconstruction with pins and cement
- 50. Case #1136 65 year female with old rh arth with multi THA’s and current pseudoarthrosis; on coumadin and painful lytic lesion ilium
- 51. CT scan looks like metastatic hemorrhagic thyroid or renal CA
- 52. hematoma Axial T-1 MRI shows large iliac hematoma and at biopsy no tumor was found
- 53. old hemorrhage Axial T-2 MRI showing large hemorrhagic pseudotumor
- 54. Case #1137 CT scan blood 91 year female with aneurysmal pseudotumor of sternum thought to be metastatic renal or thyroid met; instead an aortic aneurysm
- 55. Case #1138 70 year male with metastatic blastic prostate R hemipelvis
- 56. Bone scan
- 57. tumor Photomic showing reactive osteoid formation
- 58. Case #1138.1 84 year male with pathologic fracture humerus 2nd to metastatic lytic form of prostate CA
- 59. Case #1139 72 year male with blastic prostate mets to pelvis & L-spine
- 60. osteoid Photomic
- 61. Case #1140 Metastatic prostate 79 year male with painless blastic mets to pelvis & prox femur
- 62. osteoid tumor Photomic showing reactive osteoid
- 63. Case #1141 83 year male with lytic prostate metastasis to C-2
- 65. Photomic
- 66. Case #1142 38 year male with metastatic testicular CA & path fracture right proximal femur
- 67. Bone scan showing multiple mets to ribs, pelvis, spine, shoulder, and femur R
- 68. Rconstruction with cemented bipolar implant and RT
- 69. Sagittal T-1 MRI showing multiple mets to L-spine
- 70. Case #1143 Metastatic Lung 73 year male with lytic lung met to the intercondylar area
- 71. Lateral view
- 72. Bone scan
- 73. Coronal T-1 MRI
- 74. Coronal T-2 MRI
- 75. Axial T-1 MRI
- 76. Sagittal T-1 MRI
- 77. Sagittal T-2 MRI
- 78. Chest x-ray showing primary lung CA
- 79. Case #1143.1 55 year male with subtroch path fracture 2nd to metastatic lung CA
- 80. Lateral view
- 81. Case #1144 55 year female with metastatic lung CA to distal tibia
- 82. Chest x-ray showing primary lung CA
- 83. Case #1145 37 year male with metastatic lung CA to pelvis
- 84. CT scan
- 85. Coronal T-1 MRI
- 86. Axial T-2 MRI
- 87. Case #1146 43 year male with metastatic lung CA to distal humerus
- 88. Lateral view
- 89. Chest x-ray showing primary lung CA right apex
- 90. Case #1147 Metastatic Lung 46 year male with central fracture dislocation thru metastatic lung CA of left peri-acetabular area
- 91. Post op appearance following modified internal hemipelvec- tomy with cement and pins with THA
- 92. Case #1148 58 year male with metastatic squamous cell CA from right thigh skin to right supra-acetabular area
- 93. Post op appearance following an internal hemipelvectomy
- 94. Case #1149 43 year female with metastatic lung to distal fibula
- 95. Case #1150 44 year male with metastatic lung to distal thumb
- 96. AP view
- 97. Case #1151 Metastatic Rectal Carcinoma 46 year male with metastatic rectal CA to acetabulum
- 98. Post op appearance following cemented THA
- 100. Case #1152 Rectal Carcinoma 49 year female with blastic rectal CA metastasis to pelvis
- 101. Case #1153 Colon CA 67 year male with colon metastasis to toes with prior amp
- 102. Case #1154 Abdominal Carcinoid to Bone 74 year female with metastatic abdominal carcinoid to humerus
- 103. Post op cemented IM nail
- 104. Case #1155 Metastatic Hepatoma 62yr male with metastatic hepatoma prox femur with fracture
- 105. Lateral view
- 106. Post op ORIF
- 107. Mets to lung as well
- 108. Case #1155.1 Metastatic Hepatoma 9/9 9/26 10/21 51 yr male with pain 3 wks prior to fracture of humerus
- 109. Axial T-1 MRI Bone scan
- 110. CT of liver showing primary hepatoma lesion
- 111. Case #1156 Metastatic Gallbladder 49 year female with metastatic gallbladder CA to skull
- 113. Case #1157 Pancreatic Carcinoma to Bone 63 year male with prior history of spine fusion and recent pancreatic CA met to L-5
- 114. Photomic from L-5 biopsy
- 115. Case #1158 Transitional Bladder CA 69 year male with metastatic transitional bladder CA to femur
- 116. Cae #1159 Transitional Bladder CA to Bone 66 year male with metastatic transitional bladder CA to femur with path fracture
- 117. Axial T-2 MRI showing metastatic transitional CA to brain
- 118. Case #1160 Cervical CA 52 year female with metastatic cervical CA to R hemipelvis
- 119. Case #1161 Endometrial CA 54 year female with endometrial CA uterus to pelvis
- 120. tumor heterotopic ossification One year later without treatment
- 121. osteoid Photomic from pelvic metastatsis
- 122. photomic of endometrial adenocarcinoma
- 123. Case #1161.1 Endometrial CA 57 year female with leg and heal pain for one year
- 124. Post op cemented IM nail
- 125. Case #1161.2 Endometrial CA 63 yr female with prior history of endometrial CA
- 126. Case #1162 Metastatic Melenoma 27 year male with path fracture thru metastatic melanoma from thigh skin where he had a resection 4 yrs ago
- 127. Black pigmentation in biopsy specimen
- 128. Post op fixation with cemented IM nail
- 129. Case #1162.1 Metastatic melanoma 29 year male with pain left hip for 6 weeks
- 130. Post op x-ray
- 131. Case #1163 Metastatic Breast 53 year female with metastatic breast CA right shoulder
- 132. Biopsy specimen showing neoplastic induced osteoclysis
- 133. Case #1163.1 Metastatic Breast looking like Bone Islands 54 yr female with history of breast CA 7 yrs ago
- 134. Case #1164 16 year male with bone island proximal femur looking like a blastic metastasis
- 135. CTscan
- 136. Coronal T-2 MRI
- 137. Axial T-2 MRI
- 138. Macro section of resected bone island specimen
- 139. Case #1165 45 year female with multiple bone islands looking like mets
- 140. Case #1166 CT scan 35 year male with bone island ilium looking like a blastic metastatsis
- 141. Axial T-2 MRI
- 142. Case #1167 CT scan 56 year female with bone island looking like blastic metastasis
- 143. Negative bone scan suggests a pseudotumor diagnosis
- 144. Case #1168 43 year female with vertebral bone island looking like a blastic metastasis
- 145. Case #1168.1 Bone island Bone scan 55 year male with workup for possible bone metastasis
- 146. Cor T-1 STIR Gad
- 147. Case #1169 47 year female with stress fracture femoral neck looking like a blastic metastasis
- 148. Bone scan showing hot spot left rib and right hip
- 149. Photomic hip biopsy showing callous formation
- 150. Photomic showing callous formation
- 151. Post op bipolar prosthesis because surgeon thought patient had metastatic disease when in fact the femoral lesion and the rib fracture are osteoporotic pseudotumors
- 152. Case #1169.1 Stress fractures 43 yr female on steroids for lupus with bilat hip pain for 6 months
- 153. Bone scan
- 154. PD Cor T-1
- 155. Axial PD