Guzik Grzegorz, Barańska Beata
Orthopaedic Oncology Department, Specialized Hospital in Brzozów - Podkarpacki Oncology Centre.
Ortop Traumatol Rehabil. 2013 Jun 28;15(3):273-9. doi: 10.5604/15093492.1058425.
More bony malignancies are metastatic than primary tumours. Usually, it is not difficult to distinguish a metastasis from a primary tumour; however, when the metastasis is the first manifestation of malignant disease, diagnosis may cause numerous difficulties and lead to therapeutic errors. A patient with one year's history of pain in the right crus who was initially suspected of having sciatica and venous thrombosis was referred to an orthopaedic department when radiographs of the crus were suspicious for an osteosarcoma. CT and MRI scans revealed a tumour originating in the proximal fibula with numerous periosteal reactions. A biopsy indicated metastatic adenocarcinoma. Further diagnostic examinations didn't reveal the primary tumour. A PET scan showed a small pulmonary nodule of unknown aetiology. The patient underwent limb-sparing surgery followed by chemotherapy. The diagnostic work-up of bony malignancies may pose difficulties. Despite a characteristic presentation of sarcomas of bone in imaging examinations, it may be impossible to distinguish metastases and primary tumours. This problem especially concerns patients in whom metastases are the first manifestation of malignant disease and imaging examinations show no abnormalities in internal organs. Histopathological evaluation should be mandatory for all bone tumours which are not confirmed metastases before any therapeutic decisions are made. One must be aware of limitations and errors related to diagnostic work-up in oncology, including histopathological examinations. Sometimes it may be impossible to obtain a result of microscopic analysis compatible with the clinical presentation.
骨恶性肿瘤中转移性肿瘤比原发性肿瘤更多见。通常，区分转移瘤和原发性肿瘤并不困难；然而，当转移瘤是恶性疾病的首发表现时，诊断可能会遇到诸多困难并导致治疗失误。一名右小腿疼痛一年的患者，最初怀疑患有坐骨神经痛和静脉血栓形成，当小腿X线片怀疑骨肉瘤时被转诊至骨科。CT和MRI扫描显示起源于腓骨近端的肿瘤伴有大量骨膜反应。活检提示为转移性腺癌。进一步的诊断检查未发现原发性肿瘤。PET扫描显示一个病因不明的小肺结节。该患者接受了保肢手术并随后进行化疗。骨恶性肿瘤的诊断检查可能会遇到困难。尽管骨肉瘤在影像学检查中有特征性表现，但可能无法区分转移瘤和原发性肿瘤。这个问题尤其涉及那些转移瘤是恶性疾病首发表现且影像学检查显示内脏无异常的患者。在做出任何治疗决定之前，对于所有未确诊为转移瘤的骨肿瘤，组织病理学评估都应是必需的。必须意识到肿瘤诊断检查（包括组织病理学检查）存在的局限性和误差。有时可能无法获得与临床表现相符的显微镜分析结果。
