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