INTERESTING IMAGE
Squamous Carcinoma of the Lung Metastases to the Patella Helin Feng, MA,* Huan Li, MA,† Jin Wang, MA,* Xiaoyu Zhang, MA,* and Jiangang Feng, MD* Abstract: We report a case of a 65-year-old man with newly diagnosed squamous carcinoma of the lung, who presented with worsening left-knee pain. A bone scintigraphy displayed an increased radioactivity in the left patella. The patient underwent left patellectomy. Histopathological examination revealed metastasis to the patella from the known lung cancer. Key Words: bone scintigraphy, patellar metastasis, squamous carcinoma, lung cancer (Clin Nucl Med 2015;40: 504–505)
Received for publication October 7, 2014; revision accepted November 20, 2014. From the *Department of Orthopedics, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei; and †Postgraduate School, Tianjin Medical University, Heping, Tianjin, People's Republic of China. Conflicts of interest and sources of funding: none declared. Reprints: Jiangang Feng, Department of Orthopedics, The Fourth Affiliated Hospital of Hebei Medical University, 12 Health Rd, Shijiazhuang, Hebei 050011, People's Republic of China. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4006–0504
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REFERENCES 1. Broomfield J, Ralte P, Morapudi S, et al. Anterior knee pain: an unusual presentation of renal cell carcinoma. J Surg Case Rep. 2014;2014:rju018. 2. Tas F, Keskin S. Patellar metastasis of melanoma. Indian J Med Res. 2013;138:370. 3. Wu B, Xiu Y, Jiang L, et al. SPECT/CT imaging of patella metastasis from a squamous carcinoma of the lung. Clin Nucl Med. 2013;38:125–127. 4. Codreanu I, Zhuang H, Alavi A, et al. Patellar metastasis from lung adenocarcinoma revealed by FDG PET/CT. Clin Nucl Med. 2012;37:623–624. 5. Tudor A, Sestan B, Jonjic N, et al. Solitary metastasis of the patella in the differential diagnosis of anterior knee pain. West Indian Med J. 2010;59:110–112. 6. George MK, Venkitaraman R, Chandra A, et al. Late solitary skeletal metastasis to the patella from retinoblastoma. J Indian Med Assoc. 2008;106:313–314. 7. Nathan SS, Lim CT, Chuah BY, et al. Renal cell carcinoma bony metastasis treatment. Ann Acad Med Singapore. 2008;37:247–248. 8. Humphreys L, Sridhar M. Patellar metastasis. Lancet. 2002;359:1739. 9. Sun EC, Nelson SD, Seeger LL, et al. Patellar metastasis from a squamous carcinoma of the lung: a case report. Clin Orthop Relat Res. 2001:234–238.
Clinical Nuclear Medicine • Volume 40, Number 6, June 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 6, June 2015
Carcinoma of the Lung Metastases to the Patella
FIGURE 1. As a sesamoid bone, the patellar metastasis is considered to be unusual due to its poor vascular supply. A 65-year-old man with newly diagnosed squamous carcinoma of the lung had a worsening left-knee pain. A 99mTc-MDP bone scintigraphy was acquired to see possible bone metastases. The images revealed an increased radioactivity in the sternum and the left patella.
FIGURE 2. Preoperative CT (A, sagittal; B, coronal) and radiograph (C) of the left patella revealed osteolytic lesion and soft tissue swelling of the left knee. The results of the histopathological examination from subsequent left patellectomy showed patella metastasis from the squamous carcinoma of the lung. The subsequently taken x-ray (D) showed postoperative change. The patient complained no pain in the left knee and was able to walk without assistance at 1 year follow-up. Over the past years, only about 33 cases on patellar metastasis have been reported based on MEDLINE database.1–9 A painful swollen knee is commonly related to septic arthritis, degenerative osteoarthritis, and rheumatic arthritis. However, the possibility of patella metastasis should not be ignored in patients with malignancy. There were more than 10 cases in which the patellar symptom is the first manifestation of metastases.1,5,7–9 In such cases, accurate initial examination is important for appropriate further therapy. Although plain radiograph is commonly used, bone scintigraphy is more useful in the early diagnosis of bone metastasis. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nuclearmed.com
505
Squamous Carcinoma of the Lung Metastases to the Patella Helin Feng, MA,* Huan Li, MA,† Jin Wang, MA,* Xiaoyu Zhang, MA,* and Jiangang Feng, MD* Abstract: We report a case of a 65-year-old man with newly diagnosed squamous carcinoma of the lung, who presented with worsening left-knee pain. A bone scintigraphy displayed an increased radioactivity in the left patella. The patient underwent left patellectomy. Histopathological examination revealed metastasis to the patella from the known lung cancer. Key Words: bone scintigraphy, patellar metastasis, squamous carcinoma, lung cancer (Clin Nucl Med 2015;40: 504–505)
Received for publication October 7, 2014; revision accepted November 20, 2014. From the *Department of Orthopedics, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei; and †Postgraduate School, Tianjin Medical University, Heping, Tianjin, People's Republic of China. Conflicts of interest and sources of funding: none declared. Reprints: Jiangang Feng, Department of Orthopedics, The Fourth Affiliated Hospital of Hebei Medical University, 12 Health Rd, Shijiazhuang, Hebei 050011, People's Republic of China. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4006–0504
504
www.nuclearmed.com
REFERENCES 1. Broomfield J, Ralte P, Morapudi S, et al. Anterior knee pain: an unusual presentation of renal cell carcinoma. J Surg Case Rep. 2014;2014:rju018. 2. Tas F, Keskin S. Patellar metastasis of melanoma. Indian J Med Res. 2013;138:370. 3. Wu B, Xiu Y, Jiang L, et al. SPECT/CT imaging of patella metastasis from a squamous carcinoma of the lung. Clin Nucl Med. 2013;38:125–127. 4. Codreanu I, Zhuang H, Alavi A, et al. Patellar metastasis from lung adenocarcinoma revealed by FDG PET/CT. Clin Nucl Med. 2012;37:623–624. 5. Tudor A, Sestan B, Jonjic N, et al. Solitary metastasis of the patella in the differential diagnosis of anterior knee pain. West Indian Med J. 2010;59:110–112. 6. George MK, Venkitaraman R, Chandra A, et al. Late solitary skeletal metastasis to the patella from retinoblastoma. J Indian Med Assoc. 2008;106:313–314. 7. Nathan SS, Lim CT, Chuah BY, et al. Renal cell carcinoma bony metastasis treatment. Ann Acad Med Singapore. 2008;37:247–248. 8. Humphreys L, Sridhar M. Patellar metastasis. Lancet. 2002;359:1739. 9. Sun EC, Nelson SD, Seeger LL, et al. Patellar metastasis from a squamous carcinoma of the lung: a case report. Clin Orthop Relat Res. 2001:234–238.
Clinical Nuclear Medicine • Volume 40, Number 6, June 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 6, June 2015
Carcinoma of the Lung Metastases to the Patella
FIGURE 1. As a sesamoid bone, the patellar metastasis is considered to be unusual due to its poor vascular supply. A 65-year-old man with newly diagnosed squamous carcinoma of the lung had a worsening left-knee pain. A 99mTc-MDP bone scintigraphy was acquired to see possible bone metastases. The images revealed an increased radioactivity in the sternum and the left patella.
FIGURE 2. Preoperative CT (A, sagittal; B, coronal) and radiograph (C) of the left patella revealed osteolytic lesion and soft tissue swelling of the left knee. The results of the histopathological examination from subsequent left patellectomy showed patella metastasis from the squamous carcinoma of the lung. The subsequently taken x-ray (D) showed postoperative change. The patient complained no pain in the left knee and was able to walk without assistance at 1 year follow-up. Over the past years, only about 33 cases on patellar metastasis have been reported based on MEDLINE database.1–9 A painful swollen knee is commonly related to septic arthritis, degenerative osteoarthritis, and rheumatic arthritis. However, the possibility of patella metastasis should not be ignored in patients with malignancy. There were more than 10 cases in which the patellar symptom is the first manifestation of metastases.1,5,7–9 In such cases, accurate initial examination is important for appropriate further therapy. Although plain radiograph is commonly used, bone scintigraphy is more useful in the early diagnosis of bone metastasis. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nuclearmed.com
505
