Korean J Radiol.  2015 Feb;16(1):175-179. 10.3348/kjr.2015.16.1.175.

Solitary Osseous Metastasis of Rectal Carcinoma Masquerading as Osteogenic Sarcoma on Post-Chemotherapy Imaging: A Case Report

• Udare A
• Sable N
• Kumar R
• Thakur M
• Juvekar S

• KMID: 2069997
• DOI: http://doi.org/10.3348/kjr.2015.16.1.175

Abstract

Solitary metastases from colorectal carcinoma in the absence of hepatic or pulmonary metastases are rare. These can have a diverse imaging appearance, particularly after chemotherapy. It is important identify patients with solitary skeletal metastases, as they have a better prognosis than those with multiple skeletal or visceral metastases. We describe an unusual case of a solitary metastasis to the femur in a case of colon carcinoma that went undiagnosed and later presented with imaging features of osteogenic sarcoma.

Keyword

Colorectal neoplasms; Skeletal metastases; Osteosarcoma; Radiography; Computed tomography; MRI

MeSH Terms

Adult
Bone Neoplasms/diagnosis/radiography/secondary
Carcinoma/*diagnosis/pathology/radiography
Colorectal Neoplasms/*diagnosis/pathology/radiography
Female
Femur/radiography
Humans
Magnetic Resonance Imaging
Prognosis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Solitary osseous rectal carcinoma metastasis in 26-year-old woman. A. Plain radiograph of left femur (anteroposterior and lateral views) shows ill-defined lytic area in proximal meta-diaphyseal region of left femur with spiculated periosteal reaction (white arrow). B. Post-contrast axial computed tomography (CT) scan shows ill-defined lytic lesion with circumferential spiculated sunburst type of periosteal reaction and ill-defined soft tissue component in proximal third of diaphysis of left femur. Lesion shows intense neovasculartiy on reformatted volume-rendered coronal images. C. Magnetic resonance image of left thigh. Hypointensity is seen in radial distribution of proximal aspect of femur on axial gradient echo sequences. Peripheral enhancement was noted in soft tissue component of femoral lesion on post-contrast gadolinium T1-weighted images. D. Histopathological examination shows malignant tumor composed of dispersed population of large polygonal cells with moderate amount of vacuolated cytoplasm (H&E; × 100 [upper right image], × 200 [upper left image]). Tumor cells were immunopositive cytokeratin 20 (lower right image) and Cdx2 (lower left image) confirming metastatic adenocarcinoma of colonic origin. E. Positron emission tomography (PET)-CT scan was taken for staging prior to chemotherapy. Axial CT images confirm ill-defined lytic lesion seen in proximal left femur on plain radiograph, which is 18F-fluorodeoxyglucose-avid, as seen on fused axial PET-CT images.

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