BONE METASTASES OF NON SMALL CELL LUNG
CARCINOMA MIMICKING FEMORAL PERI-IMPLANT
FRACTURE
A Case Report.Eka Wiratnaya*, Indrayanti Mira**
*Department of Orthopaedic Surgery. Oncologic Orthopaedic Division Staff. **Department of Orthopaedic Surgery Resident
University of Udayana/Sanglah General Hospital Denpasar
Background : About 30-40% of patients affected by non-small cell lung carcinoma (NSCLC) develop during the course of their disease, bone metastases. The prognosis of these patients was poor with a median survival less than 1 year. There were 4 main radiologic modalities to diagnose metastatic bone disease (MBD): plain film radiography, CT-Scan, PET-Scan and MRI. Radiological findings commonly used to determine malignant process in the bone were osteoblastic/osteoclastic lesions, periosteal reactions, and soft tissue infiltration. The therapeutic approach includes: surgery, palliative radiotherapy and systemic therapy. Surgery should be considered when there was a likeliness of fracture or had already occurred. The goals of surgical treatment in a patient afflicted with MBD were to alleviate pain, reduce the need for pain medication, restore skeletal strength and regain functional independence.
Case : We reported a case of a 71 years old male presented with pain on his left thigh after he tripped down a 1 meter hole. The patient was presented with edema, external rotation and shortening on his left lower limb during admission. The patient had a history of chronic bloody cough and a history of weight loss for the last 3 months prior hospital admission. He also had a history of open reduction and internal fixation 15 years ago due to trauma on his left thigh. Routine thorax and femoral radiologic examination showed fluid accumulation on the left hemithorax and peri-implant fracture on the distal left femur. A left thoracostomy and a transtorachal biopsy were performed. Biopsy result showed NSCLC. Due to the lack of advanced radiologic examinations in our center, the patient was scheduled for elective frozen section prior to internal fixation. The patient was discharged from hospital and scheduled for concomitant chemo-radiotherapy.
Discussion : Radiologically, MBDs will show hypostotic lesions on specific sites. However, we reported a case where the patient with MBD showed ambiguous radiological findings due to history of internal fixation. Until now, the goals of surgical treatment for MBDs were to alleviate pain, reduce the need for pain medication, restore skeletal strength and regain functional independence. Ideally, MRI or PET-Scan were the ideal radiologic examinations for MBDs. Due to the lack of availability of these examinations in our center, we performed a frozen section prior to internal fixation procedure in this patient. Frozen section result showed a metastatic process in the bone.
Conclusion : It is important to explore the possibilities of MBDs thoroughly and the use of frozen section technique should be considered when MRI/PET Scan were not readily available.
