Metastatic or primary bone tumors frequently offer difficult problems for diagnosis.
Subjective symptoms may be present for a long time before positive x-ray findings are obtained.
In cases of suspected metastatic bone lesions, radiation therapy should be given for relief of pain, even with negative roentgenograms.
Other findings from the cases studied are as follows:
Case 1: There is apparently no definite time limit for bone metastases to follow carcinoma of the breast, even after radical surgery. This is another example of how little faith we can place in our so called five-year cure for cancer. Occasionally, generalized metastatic carcinoma may be confused with our growing knowledge of hyperparathyroidism.
Case 2: In primary neoplasms of the pelvis, pain is radiated to one or both knees without early physical signs. Later, contractures develop and the roentgenographic findings become manifest. This has been true in our two cases of malignant pelvic tumors and may be of help in diagnosis.
Case 3: Alleviation of pain is the important treatment for Hodgkin's disease, particularly when bone is involved, and x-ray therapy plays its part here. Periostitis in bone lesions frequently confounds the diagnosis instead of aiding in its clarification.
Case 4: This case represents a tumor which gives all the clinical evidence of being primary, but pathologically is proved to be of secondary origin. It is well recognized that small undiagnosable primary lesions frequently exist and the only evidence is their secondary manifestations.
Case 5: This is a case of proved epidermoid carcinoma of the cervix, which was apparently cured by radium and x-ray therapy nine months after admission, as far as the original lesion was concerned. Yet, within fourteen months of the first admission, the patient died of extensive generalized metastatic lesions, some of which were unusually located.
Case 6: Telangiectatic sarcoma is a rapidly growing and fatal form of bone malignancy. Early radical surgery is the patient's only salvation. Technically perfect roentgenograms of the chest are of the utmost importance in ruling out metastases.
(C) 1936 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.