Solitary Adenocarcinoma Metastasis Mimicking Sarcomatous Degeneration in Paget's Disease

Conrad, Gary; Johnson, Alex W.

doi:10.1097/00003072-199705000-00003

Cited by 7 publications

(6 citation statements)

References 4 publications

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“…Other neoplastic conditions that may coexist with Paget disease include metastatic disease, lymphoma, leukemia, or multiple myeloma, although this association may be fortuitous (2)(3)(4)(5)(6)(7)71,72,89,97). The differentiation of these neoplastic conditions from sarcomatous transformation is difficult unless they involve bone not affected by the Paget disease.…”

Section: Neoplastic Complications Of Paget Diseasementioning

confidence: 99%

From the Archives of the AFIP

Smith¹,

Murphey²,

Motamedi³

et al. 2002

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Paget disease of bone is a common disorder affecting approximately 3%-4% of the population over 40 years of age. The pathologic abnormality in Paget disease is excessive and abnormal remodeling of bone. Three pathologic phases have been described: the lytic phase (incipient-active), in which osteoclasts predominate; the mixed phase (active), in which osteoblasts cause repair superimposed on the resorption; and the blastic phase (late-inactive) in which osteoblasts predominate. Radiographic appearance of Paget disease reflects these pathologic changes and is often characteristic. Initially, there is osteolysis, particularly affecting the skull (osteoporosis circumscripta) and subchondral long bones, with subsequent development of trabecular and cortical thickening and enlargement of bone in the mixed phase of the disease. Finally, areas of sclerosis may develop in the blastic phase. Frequent sites of involvement include the skull (25%-65% of cases), spine (30%-75%), pelvis (30%-75%), and proximal long bones (25%-30%). Bone scintigraphy typically demonstrates marked increased uptake of radionuclide in all phases of Paget disease. Computed tomography and magnetic resonance imaging often show changes similar to those seen radiographically in noncomplicated Paget disease with maintenance of yellow marrow. Complications of Paget disease include the effects of osseous weakening (deformity and fracture), arthritis, neurologic symptoms, and neoplastic involvement. Sarcomatous transformation is the most feared complication, occurring in approximately 1% of cases, and is seen on images as focal bone destruction extending through the cortex with an associated soft-tissue mass. Recognition of the radiologic spectrum of the appearances of Paget disease usually allows prospective diagnosis and differentiation of its associated complications, which helps guide therapy and improve patient management.

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Section: Neoplastic Complications Of Paget Diseasementioning

confidence: 99%

From the Archives of the AFIP

Smith¹,

Murphey²,

Motamedi³

et al. 2002

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“…The common presenting symptoms are progressive pain, mass with or without pain and a pathological fracture as a presenting symptom or occurring during the course of the disease (Moore et al . 1991; Conrad & Johnson 1997). Half of the total (8/16) had pathological fractures in this series, of which six were treated by limb ablation surgery.…”

Section: Discussionmentioning

confidence: 99%

“…1988; Singer & Mills 1993; Ueda et al . 1996; Conrad & Johnson 1997; Katzer et al . 1997; Benthien et al .…”

Section: Introductionunclassified

Scapulo-humeral Paget's sarcoma: Scottish Bone Tumour Registry experience

2005

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This study aimed to analyse the clinical, radiological and histological features of 16 scapulo-humeral Paget's sarcoma cases accrued from Scottish Bone Tumour Registry between January 1950 and December 2000. The mean age was 61.5 (range, 44-77) years with 12 men and 4 women. There were three scapular cases and 13 humeral (1 whole length, 5 upper humeral, 5 lower humeral and 2 mid-humeral). These patients presented with progressively increasing pain in the shoulder, arm or elbow (n = 5), a painful mass associated with a pathological fracture (n = 4), a pathological fracture with progressively worsening pain (n = 3), a painful mass (n = 3) and a painless mass associated with wrist drop (n = 1). Histology showed predominantly osteosarcoma (n = 12), followed by pleomorphic sarcoma (n = 2), malignant fibrous histiocytoma (n = 1) and fibrosarcoma (n = 1). Overall, the median survival period was 4.5 months. In summary, Paget's sarcoma of the scapulo-humeral area presents with progressively worsening pain, a painful mass with or without a pathological fracture, predominantly lytic in humeral and purely sclerotic in scapular lesions, osteosarcoma-dominant histology, primarily treated with an early limb ablative surgery and associated with a poor 1-year survival (12.5%) and 5-year survival (6.2%) rate.

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“…[1][2][3] Metastatic seeding in pagetoid bones is surprisingly uncommon considering that the involved population is of high risk of developing cancer and related skeletal dissemination. [3][4][5][6] Identification of metastasis is usually incidental during evaluation for sarcomatous transformation of Paget's disease in symptomatic bone. Through a small number of publications, skeletal Paget's disease has been reported with a variable degree of F-18 FDG accumulation on PET imaging.…”

Section: Figurementioning

confidence: 99%

PET/CT Imaging of Metastatic Deposit in Vertebral Paget??s Disease

Nguyen

Ram

Roarke

2005

Clinical Nuclear Medicine

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Metastatic involvement in monostotic Paget's disease is an event of uncommon occurrence. An osseous metastasis, clinically and radiologically difficult to differentiate from sarcomatous degeneration, is often unexpectedly discovered during evaluation for malignant transformation of Paget's disease. The authors present a case of recurrent nonsmall cell lung carcinoma with PET/CT imaging instrumental in the diagnostic biopsy of a metastatic deposit in a pagetoid lumbar vertebra.

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Solitary Adenocarcinoma Metastasis Mimicking Sarcomatous Degeneration in Paget's Disease

Cited by 7 publications

References 4 publications

From the Archives of the AFIP

From the Archives of the AFIP

Scapulo-humeral Paget's sarcoma: Scottish Bone Tumour Registry experience

PET/CT Imaging of Metastatic Deposit in Vertebral Paget??s Disease

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