Biehler-Gomez Lucie, Giordano Gaia, Cattaneo Cristina
LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi Di Milano, Milan, Italy.
LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi Di Milano, Milan, Italy.
Int J Paleopathol. 2019 Mar;24:130-140. doi: 10.1016/j.ijpp.2018.10.005. Epub 2018 Oct 25.
The aim of this article is to provide additional documentation of bone metastases to help anthropologists recognize the condition and potentially suggest the diagnosis of bladder carcinoma in differential diagnosis.
Thirteen individuals clinically diagnosed with bladder carcinoma from the 20 century Milano Cemetery Skeletal Collection were macroscopically studied to document bone metastases in bladder cancer.
Bone metastases were found through macroscopic observation in three individuals or 23% of the study sample. Metastases were mostly of a mixed nature (45%), although both osteoblastic (13%) and osteolytic (9%) also occurred. In particular, mixed and osteoblastic metastases exhibited different distribution patterns, even when affecting the same bones. The vertebrae (24.7%), skull (12.9%), ribs (11.7%), proximal humeri (7.8%), pelvis (5.2%), proximal femora (2.6%), sacrum (1.3%) and sternum (1.3%) were the most commonly affected. Osteolytic lesions included coalescing superficial pits or lesions perforating the bone cortex. Proliferative lesions manifested as spongiosclerosis or periosteal new bone. Mixed metastases were osteolytic lesions exposing a thickened trabecular bone or coalescent porosity with reactive new bone.
Bladder carcinoma metastases were mostly mixed, exhibiting periosteal reactions, perforations of bone cortex, spongiosclerosis and coalescing porosity.
Bladder carcinoma is rarely considered in the differential diagnosis of the primary organ. This study reports the macroscopic aspect of bone metastases in bladder carcinoma and may help anthropologists diagnose the condition in skeletons.
Absence of evidence is not evidence of absence; some lesions may have been hidden from macroscopic observation and therefore missed.
Radiographic analysis and comparison with other neoplasms should provide additional details for the diagnosis of bladder cancer bone metastases.
本文旨在提供骨转移的补充文献资料，以帮助人类学家识别这种情况，并在鉴别诊断中可能提示膀胱癌的诊断。
对20世纪米兰公墓骨骼收藏中临床诊断为膀胱癌的13例个体进行宏观研究，以记录膀胱癌中的骨转移情况。
通过宏观观察，在3例个体（占研究样本的23%）中发现了骨转移。转移大多为混合性（45%），不过成骨（13%）和溶骨（9%）转移也有发生。特别是，混合性和成骨性转移表现出不同的分布模式，即使累及相同骨骼时也是如此。最常受累的部位是椎骨（24.7%）、颅骨（12.9%）、肋骨（11.7%）、肱骨近端（7.8%）、骨盆（5.2%）、股骨近端（2.6%）、骶骨（1.3%）和胸骨（1.3%）。溶骨性病变包括融合的浅表凹坑或穿透骨皮质的病变。增殖性病变表现为海绵状硬化或骨膜新生骨。混合性转移是溶骨性病变，伴有增厚的小梁骨或融合的孔隙以及反应性新生骨。
膀胱癌转移大多为混合性，表现为骨膜反应、骨皮质穿孔、海绵状硬化和融合的孔隙。
在原发器官的鉴别诊断中很少考虑膀胱癌。本研究报告了膀胱癌骨转移的宏观表现，可能有助于人类学家在骨骼中诊断这种情况。
没有证据并不代表不存在；一些病变可能因宏观观察而被遗漏。
影像学分析以及与其他肿瘤的比较应为膀胱癌骨转移的诊断提供更多细节。
