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Case report: Ossifying metastases from carcinoma of the large bowel demonstrated by bone scintigraphy

1995; Elsevier BV; Volume: 50; Issue: 10 Linguagem: Inglês

10.1016/s0009-9260(05)83324-0

1365-229X

J Stabler,

Bone health and treatments

A 65-year-old man was admitted with abdominal pain. He had a history of resection of a carcinoma of the sigrnoid colon two years previously, after which he had two laparotomies for episodes of intestinal obstruction, secondary to peritoneal and omental metastases. On this admission an abdominal film showed no evidence of intestinal obstruction but several amorphous clusters of calcific density were noted in the lower abdomen (Fig. 1) which had not been present on previous abdominal films. The patient was also complaining of back pain and a bone scan was performed to exclude bone metastases. This showed no abnormal skeletal uptake but very high uptake of tracer in the dense soft tissue opacities (Fig. 2). A limited CT scan was undertaken to establish the site of these lesions, demonstrating most to be in the anterior abdominal wall and left psoas (Fig. 3). The anterior abdominal wall lesions were palpable, lying within taparotomy scars, and one of these was biopsied two days later. Histologically, the fragments consisted of connective tissue which was quite densely infiltrated by metastatic adenocarcinoma. The tttmour was forming occasional glands and there was also abundant metaplastic bone formation. The bony trabeculae appeared orderly, and there was also a little osteoid. Clusters of tumour cells and also extracellular mucin were both associated with bone formation. It was concluded that this showed metastastic adenocarcinoma with metaplastic bone formation. Figure 4 shows a representative sample of the specimen. Review of the report on the microscopy of the primary tumour, excised two years previously, revealed that this too had shown adenocarcinoma 'with a few areas of mucin secretion, and in much of the tumour there is striking metaplasfic ossification'.