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  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  Acknowledgment
 ::  References

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CASE REPORTS
Year : 1992  |  Volume : 38  |  Issue : 4  |  Page : 201-2,198

Pulmonary metastases on bone scan in a patient with osteogenic sarcoma.


Dept of Nuclear Medicine, Seth G S Medical College, Bombay, Maharashtra.

Correspondence Address:
S Shikare
Dept of Nuclear Medicine, Seth G S Medical College, Bombay, Maharashtra.

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Source of Support: None, Conflict of Interest: None


PMID: 0001307596

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 :: Abstract 

This paper describes a young man who was treated with amputation for osteogenic sarcoma of the lower end of the right tibia. Pre-operative whole body bone scan with 99 mTc did not reveal abnormal tracer concentration in the lungs. A similar follow-up bone scan six months post-operatively demonstrated an area of abnormal tracer concentration in the lower lobe of each lung.


Keywords: Adolescent, Amputation, Biopsy, Bone Neoplasms, pathology,surgery,Case Report, Human, Lung Neoplasms, radionuclide imaging,secondary,Male, Osteosarcoma, radionuclide imaging,secondary,Technetium Tc 99m Medronate, diagnostic use,Tibia,


How to cite this article:
Shikare S, Tilve G H. Pulmonary metastases on bone scan in a patient with osteogenic sarcoma. J Postgrad Med 1992;38:201-2,198

How to cite this URL:
Shikare S, Tilve G H. Pulmonary metastases on bone scan in a patient with osteogenic sarcoma. J Postgrad Med [serial online] 1992 [cited 2019 Nov 17];38:201-2,198. Available from: http://www.jpgmonline.com/text.asp?1992/38/4/201/669





  ::   Introduction Top


The lung is the most common site of the metastases osteogenic sarcoma[1],[2], but bone metastases also occur with a frequency ranging from 14 to 83%[3]. This haematogenous spread can occur early and affect the prognosis adversely. Therefore, initial work-up is very important for proper management.


  ::   Case report Top


A 17-year-old male was admitted with six weeks' history of gradually increasing pain and swelling of the right leg. A radiograph revealed an osteogenic sarcoma of the distal end of the right tibia; the nature of the lesion was confirmed with biopsy.

Pre-operative whole body bone scan with99m Tc methylene diphosphonate (MDP) showed abnormal tracer concentration in the lesion, surrounding soft tissue and at the upper end of left femur [Figure:1]. No bone or pulmonary lesion was seen on X-ray of the chest or on scintiscan of the thoracic cage. The patient underwent mid leg amputation of the right lower limb. He was readmitted after six months with pain and swelling in left hip region. A bone scan revealed enlargement of the previous lesion with increased tracer uptake at the upper end of the left femur and abnormal tracer concentration at the upper end of right tibia. The same bone scan revealed an area of abnormal tracer concentration in the lower lobe of each lung [Figure:2A] & [Figure:2B]. An X-ray of the chest at this stage revealed a canon ball lesion corresponding to each of the pulmonary areas with radionucleide tracer concentration; thus they were metastases from the osteogenic sarcoma, which concentrated the bone seeking radiopharmaceutical.


  ::   Discussion Top


Bone scanning has proven to be a sensitive indicator of skeletal metastatic disease from various malignancies[4],[5]. It often shows lesions several months before radiographic changes are detectable. Uptake of bone imaging agents in pulmonary metastases from osteogenic sarcoma has been reported previously[3],[6],[7],[8]

The bone uptake of the 99mTc labelled phosphate compound has been shown to be related to immature collagen[9]. It is not known whether the same mechanism is responsible for the uptake by pulmonary metastatic nodule.

Thus, at least with osteogenic sarcoma, the pulmonary metastases may be detected as a result of their concentrating the same radionucleide, which is used for the bone scan. This seems to be a bonus of the whole body bone scan


  ::   Acknowledgment Top


We thank the Dean, Seth G S Medical College and KEM Hospital for allowing us the publication of this case report.

 
 :: References Top

1. Hayles AB, Dahilin DC, Conventary MB. Osteogenic sarcoma in children. JAMA 1960; 1174:1174.  Back to cited text no. 1    
2.Mckanna RJ, Schwinn CP, Soong KY. Sarcomata of the osteogenic series (osteosarcoma, fibrosarcoma, chondrosarcoma, periosteal osteogenic sarcoma and sarcomata arising in abnormal bone). An analysis of 552 cases. J Bone Joint Surg 1966; 48A:1-7.  Back to cited text no. 2    
3.Cohen Y, Brook C, Sobel JO. Sr. 85 Uptake in lung metastases of osteogenic sarcoma. Oncology 1974; 30:493-496.  Back to cited text no. 3    
4.Osmond JD III, Pendegrass HP, Postsaid MS. Accuracy of 99mTc diphosphonate bone scan and roentgenogram in the detection of prostate, breast and lung carcinoma metastases, Am J Roentgenol 1975; 125:972-977.  Back to cited text no. 4    
5.Shirazi PH, Rayuclu GVB. Bone scanning. Review of indications and results of 1500 scans. Radiology 1974; 112:361-366.  Back to cited text no. 5    
6.Brower AC, Teates CD. Positive 9gmTc polyphosphate scan in case of metastatic osteogenic sarcoma and hypertrophic pulmonary osteoarthropathy. J Nuct Med. 1974; 15:53-56.  Back to cited text no. 6    
7.Ghaed Y, Thrall JH, Pinsky SM. Detection of extraosseous metastases from osteosarcoma with 99mTc polyphosphate bone scanning. Radiology 1974; 112:373-376.  Back to cited text no. 7    
8.McNefl BJ, Cassady JR, Geiser CF. Flurine 18 bone scintigraphy in children with osteosarcoma or Ewinge sarcoma. Radiology 1973; 109:627-630.  Back to cited text no. 8    
9.Kaye M, S'livertone S, Rosenthall L. Technetium 99mTc pyrophosphate: Studies in vivo and in vitro. J Nucl Med 1975; 16:40-43   Back to cited text no. 9    



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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow