Revannasiddaiah Swaroop, Rastogi Madhup, Thakur Pragyat, Gupta Manoj Kumar, Sood Ashwani, Sharma Chittranjan
Department of Radiotherapy & Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
BMJ Case Rep. 2012 Jul 9;2012:bcr2012006265. doi: 10.1136/bcr-2012-006265.
This report describes the case of a gentleman aged 59 years presenting with low-back pain, who had underwent radical prostatectomy for prostate cancer 8 years ago. On evaluation, a slightly elevated serum alkaline-phosphatase level prompted a search for bone metastases. Although x-ray radiography and a bone scan were apparently normal, an MRI scan revealed the presence of metastatic marrow infiltration in the lumbar vertebrae. The patient subsequently was initiated on therapy with androgen-deprivation therapy and bisphosphonates, and currently enjoys symptom-free and progression-free survival. The images in this paper intend to impress upon the limitations of bone scan and x-ray radiography with regard to the detection of vertebral marrow infiltration in the absence of cortical bone invasion. In addition, a brief review of the pathophysiology of vertebral metastases arising from prostate cancer is included.
本报告描述了一位59岁男性患者的病例，该患者因腰痛就诊，8年前曾因前列腺癌接受根治性前列腺切除术。经评估，血清碱性磷酸酶水平略有升高促使对骨转移进行排查。尽管X线摄影和骨扫描结果看似正常，但MRI扫描显示腰椎存在转移性骨髓浸润。该患者随后开始接受雄激素剥夺疗法和双膦酸盐治疗，目前无症状且无疾病进展地存活。本文中的影像旨在强调在无皮质骨侵犯情况下，骨扫描和X线摄影在检测椎体骨髓浸润方面的局限性。此外，还包括对前列腺癌所致椎体转移病理生理学的简要综述。
