Vol 12 ppt

Volume 12

Metastatic carcinoma----------Case 1122-1169

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

One year later with

recurrent tumor

Surgical specimen

following wide resection

proximal femur

tumor

bulge

Photomic

Autoclaved prox femur

placed over long stem

femoral component

Cemented back in

normal anatomic position

with THA

osteotomy

cement

5 months post op with

radiolucent cement

18 months post op

Case #1124

58 year male with metastatic renal cell CA to pelvis

Post op treatment with

radiolucent cement

THA and radiation therapy

Case #1125

65 year male with path fracture thru metastatic renal cell CA

in sciatic notch area

Case #1126

48 year male with large

hemorrhagic renal cell

CA distal humerus

tumor

Case #1127

66 year male with

metastatic renal cell CA

post op ORIF, pin

fixation and post op RT

Case #1128

61 year female with metastatic renal cell CA hip area

Lytic lesion in clavicle

Multiple lesions in both hands

Metastatic Renal Cell

Case #1128.1

57 year male with renal cell CA metastasis to fibular

6 months later without treatment

Bone scan

Sagittal T-2 MRI

Photomic

Case #1129

61 year female with metastatic aneurysmal

renal cell CA to distal tibia

Photomic

Case #1130

45 year male with metastatic renal cell CA to os calcis

Metastatic Renal Cell

Sagital T-1 MRI

Sagittal T-2 MRI

tumor

Axal T-1 MRI

Axial T-2 MRI

Photomic

Case #1131

54 year female with metastatic aneurysmal thyroid to pelvis

CT scan

Case #1132

45 year female with lytic thyroid metastasis to pelvis

Rapid progression without treatment 6 months later

tumor tumor

Case #1133

52 year female with metastatic thyroid CA to pelvis

MetastaticThyroid

Case #1134

54 year female with metastatic thyroid CA to pelvis

Case #1135

48 yr male with metastatic blastic thyroid met to femoral neck

Bone scan

Case #1135.1

21 year female with large pelvic mass which turned out to be

a metastatic thyroid metastasis from an ovarian teratoma

Pelvic metastasis seen on PO x-ray following teratoma surgery

Bone scan

tumor

Sciatic notch level

tumor

Supra acetabular level

tumor

I-131 isotope scan prior to teratoma surgery shows

uptake in both the ovarian teratoma and pelvic met

Surgical specimen from resection of pelvic metastasis

Photomic from thyroid metastasis

Placement of multiple Steinman pins prior to cementation

Bone cement placed over pins

Post op reconstruction with pins and cement

Case #1136

65 year female with old rh arth with multi THA’s and current

pseudoarthrosis; on coumadin and painful lytic lesion ilium

CT scan looks like metastatic hemorrhagic thyroid or renal CA

Axial T-1 MRI shows large iliac hematoma and at biopsy

no tumor was found

hematoma

Axial T-2 MRI showing large hemorrhagic pseudotumor

old hemorrhage

Case #1137

91 year female with aneurysmal pseudotumor of sternum thought

to be metastatic renal or thyroid met; instead an aortic aneurysm

blood

CT scan

Case #1138

70 year male with metastatic blastic prostate R hemipelvis

Bone scan

Photomic showing reactive osteoid formation

tumor

Case #1138.1

84 year male with pathologic

fracture humerus 2nd to

metastatic lytic form of

prostate CA

Case #1139

72 year male with blastic prostate mets to pelvis & L-spine

Photomic

osteoid

Case #1140

79 year male with painless blastic mets to pelvis & prox femur

Metastatic prostate

Photomic showing reactive osteoid

tumor

osteoid

Case #1141

83 year male with lytic

prostate metastasis to

C-2

Lateral laminogram

Photomic

Case #1142

38 year male with metastatic testicular CA & path fracture

right proximal femur

Bone scan showing

multiple mets to ribs,

pelvis, spine, shoulder,

and femur

R

Rconstruction with cemented bipolar implant and RT

Sagittal T-1 MRI

showing multiple mets

to L-spine

Case #1143

73 year male with lytic lung met to the intercondylar area

Metastatic Lung

Lateral view

Bone scan

Coronal T-1 MRI

Coronal T-2 MRI

Axial T-1 MRI

Sagittal T-1 MRI

Sagittal T-2 MRI

Chest x-ray showing primary lung CA

Case #1143.1

55 year male with

subtroch path fracture

2nd to metastatic lung CA

Lateral view

Case #1144

55 year female with

metastatic lung CA

to distal tibia

Chest x-ray showing primary lung CA

Case #1145

37 year male with metastatic lung CA to pelvis

CT scan

Coronal T-1 MRI

Axial T-2 MRI

Case #1146

43 year male with

metastatic lung CA

to distal humerus

Lateral view

Chest x-ray showing primary lung CA right apex

Case #1147

46 year male with central fracture dislocation thru metastatic

lung CA of left peri-acetabular area

Metastatic Lung

Post op appearance following

modified internal hemipelvec-

tomy with cement and pins

with THA

Case #1148

58 year male with

metastatic squamous

cell CA from right

thigh skin to right

supra-acetabular area

Post op appearance following an internal hemipelvectomy

Case #1149

43 year female with

metastatic lung to

distal fibula

Case #1150

44 year male with metastatic lung to distal thumb

AP view

Case #1151

46 year male with metastatic rectal CA to acetabulum

Metastatic Rectal Carcinoma

Post op appearance following

cemented THA

Acetabular biopsy photomic

Case #1152

49 year female with blastic rectal CA metastasis to pelvis

Rectal Carcinoma

Case #1153

67 year male with colon metastasis to toes with prior amp

Colon CA

Case #1154

74 year female with

metastatic abdominal

carcinoid to humerus

Abdominal Carcinoid to Bone

Post op cemented

IM nail

Case #1155

62yr male with metastatic hepatoma prox femur with fracture

Metastatic Hepatoma

Lateral view

Post op ORIF

Mets to lung as well

Case #1155.1 Metastatic Hepatoma

9/9 9/26 10/21

51 yr male with pain 3 wks prior to fracture of humerus

Axial T-1 MRI Bone scan

CT of liver showing primary hepatoma lesion

Case #1156

49 year female with metastatic gallbladder CA to skull

Metastatic Gallbladder

Photomic skull biopsy

Case #1157

63 year male with prior

history of spine fusion

and recent pancreatic

CA met to L-5

Pancreatic Carcinoma to Bone

Photomic from L-5 biopsy

Case #1158

69 year male with

metastatic transitional

bladder CA to femur

Transitional Bladder CA

Cae #1159

66 year male with metastatic

transitional bladder CA

to femur with path fracture

Transitional Bladder CA to Bone

Axial T-2 MRI showing

metastatic transitional

CA to brain

Case #1160

52 year female with metastatic cervical CA to R hemipelvis

Cervical CA

Case #1161

54 year female with endometrial CA uterus to pelvis

Endometrial CA

One year later without treatment

tumor

heterotopic ossification

Photomic from pelvic metastatsis

osteoid

photomic of endometrial adenocarcinoma

Case #1161.1

57 year female with leg and heal pain for one year

Endometrial CA

Post op cemented IM nail

Case #1161.2 Endometrial CA

63 yr female with prior history of endometrial CA

Case #1162

27 year male with path

fracture thru metastatic

melanoma from thigh

skin where he had a

resection 4 yrs ago

Metastatic Melenoma

Black pigmentation in biopsy specimen

Post op fixation with

cemented IM nail

Case #1162.1

29 year male with pain left hip for 6 weeks

Metastatic melanoma

Post op x-ray

Case #1163

53 year female with

metastatic breast CA

right shoulder

Metastatic Breast

Biopsy specimen showing neoplastic induced osteoclysis

Case #1163.1 Metastatic Breast looking like Bone Islands

54 yr female with history of breast CA 7 yrs ago

Case #1164

16 year male with bone

island proximal femur

looking like a blastic

metastasis

CTscan

Coronal T-2 MRI

Axial T-2 MRI

Macro section of resected bone island specimen

Case #1165

45 year female with multiple bone islands looking like mets

Case #1166

35 year male with bone island ilium looking like a

blastic metastatsis

CT scan

Axial T-2 MRI

Case #1167 CT scan

56 year female with bone island looking like blastic metastasis

Negative bone scan suggests a pseudotumor diagnosis

Case #1168

43 year female with

vertebral bone island

looking like a blastic

metastasis

Case #1168.1

55 year male with workup for possible bone metastasis

Bone scan

Bone island

Cor T-1 STIR Gad

Case #1169

47 year female with stress fracture femoral neck looking like

a blastic metastasis

Bone scan showing hot

spot left rib and right hip

Photomic hip biopsy showing callous formation

Photomic showing callous formation

Post op bipolar prosthesis

because surgeon thought

patient had metastatic

disease when in fact the

femoral lesion and the

rib fracture are osteoporotic

pseudotumors

Case #1169.1

43 yr female on steroids for lupus with bilat hip pain for 6 months

Stress fractures

Bone scan

Cor T-1

PD

Axial PD