Bone Metastases Non Small Lung Cell Carcinoma Mimicking Peri-Implant.
BONE METASTASES OF NON SMALL CELL LUNG
CARCINOMA MIMICKING FEMORAL PERI-IMPLANT
FRACTURE
A Case Report.
Eka Wiratnaya*, Indrayanti Mira**
*Department of Orthopaedic Surgery. Oncologic Orthopaedic Division Staff.
**Department of Orthopaedic Surgery Resident
University of Udayana/Sanglah General Hospital Denpasar
Background : About 30-40% of patients affected by non-small cell lung carcinoma
(NSCLC) develop during the course of their disease, bone metastases. The prognosis of these
patients was poor with a median survival less than 1 year. There were 4 main radiologic
modalities to diagnose metastatic bone disease (MBD): plain film radiography, CT-Scan,
PET-Scan and MRI. Radiological findings commonly used to determine malignant process in
the bone were osteoblastic/osteoclastic lesions, periosteal reactions, and soft tissue
infiltration. The therapeutic approach includes: surgery, palliative radiotherapy and systemic
therapy. Surgery should be considered when there was a likeliness of fracture or had already
occurred. The goals of surgical treatment in a patient afflicted with MBD were to alleviate
pain, reduce the need for pain medication, restore skeletal strength and regain functional
independence.
Case : We reported a case of a 71 years old male presented with pain on his left thigh after he
tripped down a 1 meter hole. The patient was presented with edema, external rotation and
shortening on his left lower limb during admission. The patient had a history of chronic
bloody cough and a history of weight loss for the last 3 months prior hospital admission. He
also had a history of open reduction and internal fixation 15 years ago due to trauma on his
left thigh. Routine thorax and femoral radiologic examination showed fluid accumulation on
the left hemithorax and peri-implant fracture on the distal left femur. A left thoracostomy and
a transtorachal biopsy were performed. Biopsy result showed NSCLC. Due to the lack of
advanced radiologic examinations in our center, the patient was scheduled for elective frozen
section prior to internal fixation. The patient was discharged from hospital and scheduled for
concomitant chemo-radiotherapy.
Discussion : Radiologically, MBDs will show hypostotic lesions on specific sites. However,
we reported a case where the patient with MBD showed ambiguous radiological findings due
to history of internal fixation. Until now, the goals of surgical treatment for MBDs were to
alleviate pain, reduce the need for pain medication, restore skeletal strength and regain
functional independence. Ideally, MRI or PET-Scan were the ideal radiologic examinations
for MBDs. Due to the lack of availability of these examinations in our center, we performed a
frozen section prior to internal fixation procedure in this patient. Frozen section result showed
a metastatic process in the bone.
Conclusion : It is important to explore the possibilities of MBDs thoroughly and the use of
frozen section technique should be considered when MRI/PET Scan were not readily
available.
.Keywords: Metastatic bone disease, non-small lung cell carcinoma, surgical therapy.
CARCINOMA MIMICKING FEMORAL PERI-IMPLANT
FRACTURE
A Case Report.
Eka Wiratnaya*, Indrayanti Mira**
*Department of Orthopaedic Surgery. Oncologic Orthopaedic Division Staff.
**Department of Orthopaedic Surgery Resident
University of Udayana/Sanglah General Hospital Denpasar
Background : About 30-40% of patients affected by non-small cell lung carcinoma
(NSCLC) develop during the course of their disease, bone metastases. The prognosis of these
patients was poor with a median survival less than 1 year. There were 4 main radiologic
modalities to diagnose metastatic bone disease (MBD): plain film radiography, CT-Scan,
PET-Scan and MRI. Radiological findings commonly used to determine malignant process in
the bone were osteoblastic/osteoclastic lesions, periosteal reactions, and soft tissue
infiltration. The therapeutic approach includes: surgery, palliative radiotherapy and systemic
therapy. Surgery should be considered when there was a likeliness of fracture or had already
occurred. The goals of surgical treatment in a patient afflicted with MBD were to alleviate
pain, reduce the need for pain medication, restore skeletal strength and regain functional
independence.
Case : We reported a case of a 71 years old male presented with pain on his left thigh after he
tripped down a 1 meter hole. The patient was presented with edema, external rotation and
shortening on his left lower limb during admission. The patient had a history of chronic
bloody cough and a history of weight loss for the last 3 months prior hospital admission. He
also had a history of open reduction and internal fixation 15 years ago due to trauma on his
left thigh. Routine thorax and femoral radiologic examination showed fluid accumulation on
the left hemithorax and peri-implant fracture on the distal left femur. A left thoracostomy and
a transtorachal biopsy were performed. Biopsy result showed NSCLC. Due to the lack of
advanced radiologic examinations in our center, the patient was scheduled for elective frozen
section prior to internal fixation. The patient was discharged from hospital and scheduled for
concomitant chemo-radiotherapy.
Discussion : Radiologically, MBDs will show hypostotic lesions on specific sites. However,
we reported a case where the patient with MBD showed ambiguous radiological findings due
to history of internal fixation. Until now, the goals of surgical treatment for MBDs were to
alleviate pain, reduce the need for pain medication, restore skeletal strength and regain
functional independence. Ideally, MRI or PET-Scan were the ideal radiologic examinations
for MBDs. Due to the lack of availability of these examinations in our center, we performed a
frozen section prior to internal fixation procedure in this patient. Frozen section result showed
a metastatic process in the bone.
Conclusion : It is important to explore the possibilities of MBDs thoroughly and the use of
frozen section technique should be considered when MRI/PET Scan were not readily
available.
.Keywords: Metastatic bone disease, non-small lung cell carcinoma, surgical therapy.