Metastasis of adenocarcinoma of an unknown primary site to the right crus simulating sarcoma - a case report
Journal Title: Ortopedia Traumatologia Rehabilitacja - Year 2013, Vol 15, Issue 3
Abstract
More bony malignancies are metastatic than primary tumours. Usually, it is not difficult to distinguish a metastasis from a primary tumour; however, when the metastasis is the first manifestation of malignant disease, diagnosis may cause numerous difficulties and lead to therapeutic errors. A patient with one year’s history of pain in the right crus who was initially suspected of having sciatica and venous thrombosis was referred to an orthopaedic department when radiographs of the crus were suspicious for an osteosarcoma. CT and MRI scans revealed a tumour originating in the proximal fibula with numerous periosteal reactions. A biopsy indicated metastatic adenocarcinoma. Further diagnostic examinations didn’t reveal the primary tumour. A PET scan showed a small pulmonary nodule of unknown aetiology. The patient underwent limb-sparing surgery followed by chemotherapy. The diagnostic work-up of bony malignancies may pose difficulties. Despite a characteristic presentation of sarcomas of bone in imaging examinations, it may be impossible to distinguish metastases and primary tumours. This problem especially concerns patients in whom metastases are the first manifestation of malignant disease and imaging examinations show no abnormalities in internal organs. Histopathological evaluation should be mandatory for all bone tumours which are not confirmed metastases before any therapeutic decisions are made. One must be aware of limitations and errors related to diagnostic work-up in oncology, including histopathological examinations. Sometimes it may be impossible to obtain a result of microscopic analysis compatible with the clinical presentation.
Authors and Affiliations
Grzegorz Guzik , Beata Barańska
Keywords
Related Articles
- EP ID EP57327
- DOI -
- Views 106
- Downloads 0
Postoperative Migration of Short Stem Prosthesis of the Hip Joint
Background. Hip replacement surgery is a popular procedure that provides predictable, long-lasting and good effects. The use of short stem prostheses helps preserve an intact medullary cavity and proximal diaphysis. It h...
Wyniki leczenia operacyjnego skolioz idiopatycznych metodą trójpłaszczyznowej korekcji ze spondylodezą
Wstęp. Metodę operacyjnej trójpłaszczyznowej korekcji skolioz wprowadził Cotrel w latach 80-tych XX wieku. W początkowym okresie, do korekcji i stabilizacji kręgosłupa wykorzystywano haki laminarne lub pedikularne, dwa p...
Complications of dislocated calcaneal fractures
Summary Introduction: calcaneal fractures are the most common of all tarsal fractures, with the majority being the result of high energy injuries causing comminution of bone and lesions of the posterior articular surface...
Various attitudes to the use of corrective exercises in conservative treatment of scoliosis
In acquired scoliosis, the degree of the curve is initially low and its type becomes apparent only after it has progressed. The characteristics of scoliosis include an abnormal spatial arrangement of individual body segm...
High trochanter location: Natural history or complication following treatment of Perthes' disease?
Background. In Perthes' disease femoral head deformities can be accompanied by high location of the greater trochanter and diminished shaft-neck angle, causing decreased joint stability and diminished hip function. The a...