Sclerotic bone metastases from sarcomatoid renal cell carcinoma

We present a case of sarcomatoid renal cell carcinoma with multiple sclerotic skeletal metastatic lesions. Renal cell carcinoma is frequently metastatic at presentation, with a high incidence of skeletal involvement, classically described as osteolytic. However, sclerotic or osteoblastic metastatic skeletal lesions from renal cell carcinoma are rare, with only two previous reports identified in the literature, neither of which involved the sarcomatoid variant of renal cell carcinoma. In our case the sclerotic metastases were characterized by bone scan, computed tomography (CT), magnetic resonance imaging (MRI), and histologic analysis. Received: 8 April 1999 Revision requested: 27 May 1999 Revision received: 24 June 1999 Accepted: 29 June 1999     

Radiographic manifestations of bone metastases from renal carcinoma.

From 1964 to 1974, 1,668 patients with renal carcinoma were seen at the Mayo Clinic. Bone metastases were present in 167 of these patients (only lung metastatic involvement ranked higher in frequency). More than one-third of the patients with bone metastasis from renal carcinoma had this as a presenting lesion of occult renal tumor. This group constituted 4% of all patients with renal carcinoma evaluated during the study period. While most bone lesions were in the pelvis and lower lumbar spine, any bone may be involved. All patients with bone metastases from renal carcinoma have a poor prognosis. However, some bone lesions appeared as long as 10 or more years after the initial tumor. The most common radiographic features are a lytic destructive process with indistinct margins, erosion of the cortex, and frequent expansion into the soft tissues. Pathological features are common in the long bones, and calcifications are occasionally seen. The synovial joints are not affected. A well defined sclerotic margin is a common finding after radiation treatment, although it is not a reliable indicator of the stability of the lesion.     

Preoperative embolization of bone metastases from renal cell carcinoma

The purpose of this study was to correlate the effectiveness of preoperative embolization with the blood loss and transfusion requirement during surgery for bone metastases from renal cell carcinoma. Twenty-eight preoperative embolizations in 26 patients with renal cell carcinoma metastatic to bone were retrospectively evaluated and divided into two groups: Group A included the embolizations that resulted in complete devascularization of the lesion as defined by the post-embolization arteriograms, and group B included those with an incomplete result. The two groups were compared with regard to blood loss and transfusion requirement during surgery, by unpaired two-tailed Student's t-test. Where complete embolization was effected (group A, 10 cases), there was a mean blood loss of 535 ± 390 ml. When a less than complete embolization was achieved (group B, 18 cases), the mean blood loss was 1.247 ± 1.047 ml (p = 0.049). The red blood cell transfusion in group A was 1.3 ± 1 units, whereas in group B it was 2.4 ± 1.2 (p = 0.03). Preoperative embolization of bone metastases from renal cell carcinoma with subsequent complete devascularization leads to significant reduction of blood loss during surgery. Interventional radiologists should pursue and embolize every feeder to the metastasis, because any less than complete devascularization increases the amount of blood loss and the amount of red blood cell transfusion during surgery. Received: 23 June 1998; Revised: 20 November 1998; Accepted: 24 February 1999     

Adrenal and renal metastases from follicular thyroid cancer

Patients with differentiated thyroid cancer may have asymptomatic involvement of renal and/or adrenal gland, particularly if they are elderly and have associated metastases to other organs, which may remain undetected if these patients are not subjected to radioiodine treatment. Our experience also emphasises the role of routine post-radioiodine therapy whole body scan with high degree of clinical suspicion, which may reveal lesions otherwise not discernable in low dose whole body scan. All suspicious lesions should be subjected to structural imaging like ultrasound, CT or MRI for confirmation. In this setting, the role of radioiodine therapy is primarily aimed at palliation that might prolong their survival, probably reduce further spread and thus overall improve the quality of life.     

乳腺癌骨转移临床相关因素的研究

目的 研究乳腺癌骨转移的临床和影像学资料,寻找影响骨转移的相关因素,为早期诊断提供依据.方法 对334例乳腺癌患者全身骨显像、临床分期、病理、免疫组织化学及血清学检-查结果进行回顾性分析,并对数据行χ2检验.结果 有淋巴结转移者骨转移率71.0%（152/214）,没有淋巴结转移者骨转移率为22.5%（27/120）,两者比较差异有统计学意义（χ2=72.80,P=0.000） 浸润性非特殊性癌骨转移率69.0%（203/294）,浸润性特殊性癌骨转移率41.7%（5/12）,两者比较差异有统计学意义（χ2=3.97,P=0.046） 骨转移中碱性磷酸酶（ALP）升高者占28.5%（51/179）,非骨转移中ALP升高者占14.9%（11/74）,两者比较差异也有统计学意义（χ2=5.25,P=0.022） 而骨转移中肿瘤标志物[癌胚抗原（CEA）、糖类抗原（CA）15-3、CA125、CA19-9]升高者占68.7%（123/179）,非骨转移中肿瘤标志物升高者占27.0%（20/74）（χ2=37.03,P=0.000）.结论 乳腺癌骨转移的发生率与原发灶的病理类型、发病时有无淋巴结转移有关,浸润性非特殊性癌或有淋巴结转移者骨转移率较高.动态监测血清ALP、CEA、CA15-3、CA125、CA19-9有助于早期诊断.     

乳腺癌骨转移临床相关因素的研究

Objective To study the clinical and imaging features of patients with bone metastases from breast cancer and identify the factors related to the incidence of bone metastases. Methods Three hundred and thirty-four patients with breast cancer were recruited into this study. Whole-body 99Tcm-methylene disphosphonate (MDP) bone scan, clinical staging, pathological, immunohistochemical and serological test results were analyzed retrospectively. χ2 test was used for statistical analysis. Results The incidence rate of bone metastases for patients with and without lymph node metastases was 71% (152/214) and 22. 5% (27/120), respectively (χ2 =72.80, P =0.000). The incidence rate of bone metastases from infiltrated non-specified and specified breast cancer was 69% (203/294) and 41.7% (5/12), respectively (χ2 =3. 97, P=0.046). Alkaline phosphatase (ALP) was elevated in 28.5% (51/179) and 14.9%(11/74) of patients with and without bone metastases, respectively (χ2 = 5. 25, P = 0.022 ). Carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 15-3, CA125, CA19-9 increased in 68.7% ( 123/179) and 27.0% (20/74) of patients with and without bone metastases, respectively (χ2 = 37. 03, P =0. 000). Conclusions The incidence of bone metastases from breast cancer is correlated to pathological types of primary tumor and lymph node metastases. Bone metastases occurs more frequently in patients with infiltrated, non-specified, primary cancer and with lymph node metastases. Serum ALP, CEA, CA15-3,CA125, CA19-9 might be the tumor makers for early diagnosis of bone metastases from breast cancer.     

99mTc-tetrofosmin uptake in bone metastases from breast cancer

^99mTc-tetrofosmin myocardial imaging was performed in a 62-year-old woman who had undergone standard radical mastectomy for right breast cancer 6 years ago. Although the result was negative for the ischemic heart disease, it showed abnormal accumulation corresponding to the bone metastases in the spine. We believe that^99mTc-tetrofosmin imaging is helpful in detecting bone metastases from breast cancer.     

Preoperative transarterial Embolisation in bone tumors

Bone tumors include a variety of lesions, both primary and metastatic. The treatment modalities for bone tumors vary with the individual lesion, but in general surgical excision is the treatment of choice with other adjunctive therapies. However, surgery for many bone tumors is complex due to several factors including tumor bulk, vascularity, vicinity to vital structures and potentially inaccessible location of the lesion. Transarterial Embolisation (TAE) is one of the important adjuvant treatment modalities and in some cases it may be the primary and curative treatment. Preoperative TAE has proved to be effective in both primary and metastatic bone tumors. It reduces tumor vascularity and intraoperative blood loss, the need for blood transfusion and associated complications, allows better definition of tissue planes at surgery affording more complete excision, and hence reduced recurrence. Preoperative chemoEmbolisation has also been shown to increase the sensitivity of some tumors to subsequent chemotherapy and radiotherapy. There are several techniques and embolic agents available for this purpose, but the ultimate aim is to achieve tumor devascularization. In this review, we discuss the techniques including the choice of embolic agent, application to individual lesions and potential complications.     

Radioimmune imaging of bone marrow in patients with suspected bone metastases from primary breast cancer

Radioimmune imaging of bone marrow was performed by technetium-99m- (99mTc) labeled antigranulocyte monoclonal antibody BW 250/183 (AGMoAb) scans in 32 patients with suspected bone metastases from primary breast cancer. AGMoAb scans showed bone marrow defects in 25/32 (78%) patients; bone invasion was subsequently confirmed in 23 (72%) patients. Conventional bone scans performed within the same week detected bone metastases in 17/32 (53%) patients (p less than 0.001). AGMoAb scans detected more sites indicating metastatic disease than bone scans in 12 of these 17 patients (71%). All patients with bone metastases in the axial skeleton had bone marrow defects at least at the sites of bone metastases. Of 15 patients with normal, or indicative of, benign disease bone scans, 8 patients (53%) presented with bone marrow defects in the AGMoAb scans. Bone invasion was confirmed in six of them. AGMoAb bone marrow scans provide a method for the early detection of bone metastatic invasion in patients with breast cancer and suspected bone metastases.     

Bone metastases from breast cancer: value of CT bone windows.

A pilot study was organized to compare the utility of scintigraphy, radiographic bone surveys, and conventional CT bone windows (CTBWs) in judging therapeutic response of bone lesions in patients with metastatic breast carcinoma. Twenty-six patients with stage IV disease and documented bone metastases were evaluated over a 2 year period. Discordance in the assessment of therapeutic response was greatest (56% discordance) between bone scans (BSs) and conventional CTBWs. In 77% of the discordant observations, the assessment by conventional CTBWs agreed with the patients' clinical response to therapy. Our preliminary results suggest that posttherapy review of conventional CTBWs provides useful clinical information about therapeutic response and exceeds the contribution of BSs in this regard.     

Clinical results and prognostic factors of radiotherapy for bone metastases from breast cancer

The purpose of this study was to analyze the results of initial radiotherapy for bone metastases (BM) from breast cancer and to investigate the prognostic factors. Between 1981 and 1995, 65 women (109 lesions) received initial radiotherapy for BM, aiming at a total dose of 50 Gy/25 Fr. Significant relief of pain was obtained in 61 (88.4%) of 69 estimable lesions according to the RTOG score. The control rates of pain including the prevention of pathological fractures or myelopathy were 80.4% at 5 years and 64.3% at 10 years. The median survival time of all patients was 11 months, and the survival rates were 56% at 1 year, 31.6% at 3 years, 17.9% at 5 years and 10.7% at 10 years, with five long-term survivors. Univariate analysis showed that a normal state of LDH, no other metastatic organs, a disease-free interval longer than two years, good performance status (0 or 1), BM limited to the axial bones, maintenance chemo-hormonal therapy and an age of more than 55 years were good prognostic factors. Multivariate analysis showed that LDH, age and performance status were significant predictors of prognosis. It is important to note the prognostic factors at the initial treatment of BM from breast cancer. We consider that further prospective studies are needed to determine the optimal treatment schedule, including radiotherapy and its combination with chemohormonal therapy, for BM.     

Comparison of whole-body MR imaging and bone scintigraphy in the detection of bone metastases from breast cancer

The aim of this study was to investigate the usefulness of whole body MR imaging (WB-MRI) in the detection of bone metastases from breast cancer and to compare the results with those from bone scintigraphy. In 21 patients with suspected bone metastasis from breast cancer, both bone scintigraphy and WB-MRI were performed. With WB-MRI, coronal images were obtained using a body coil in an FOV of 48 cm, and sequences of fast short TI inversion recovery (STIR) and gadolinium-enhanced fast spoiled GRASS (SPGR) were used in three parts: from the head to the thorax, the abdomen to the pelvis, and the lower extremities. Of the total 105 metastatic bone lesions, 65 (61.9%) were detected by bone scintigraphy, 98 (93.3%) by fast STIR, and 74 (70.5%) by fast SPGR. Thus, the detection of bone metastases by WB-MRI was excellent. However, detectability in the ribs was lower for WB-MRI than for bone scintigraphy. Contrast-enhanced MRI was useful in the differentiation of osteosclerotic lesions, in which high signal intensity is rare, pleural effusion, which has high signal intensity on STIR, and bone metastatic lesions. In conclusion, WB-MRI showed high reliability in the detection of bone metastatic lesions from breast cancer.     

Ureteral and renal pelvic metastases from renal cell carcinoma

Six patients with ureteral or renal pelvic metastases from renal cell carcinoma (RCC) were studied radiologically. Correlation with surgical and histologic findings confirmed renal venous involvement in 5 and lymphatic invasion in 3 patients. The possible role of nephroureterectomy or secondary ureterectomy in patients with RCC is discussed in the background of our cases, as are prior reports of this finding.     

Ureteral and renal pelvic metastases from renal cell carcinoma

Six patients with ureteral or renal pelvic metastases from renal cell carcinoma (RCC) were studied radiologically. Correlation with surgical and histologic findings confirmed renal venous involvement in 5 and lymphatic invasion in 3 patients. The possible role of nephroureterectomy or secondary ureterectomy in patients with RCC is discussed in the background of our cases, as are prior reports of this finding.