![]() ![]() Malignant and metastatic lesions are usually eccentric and involve the cortex. Radiographs should be carefully assessed for osteopenia, periostal thickening, abnormal radiodensities, and calcifications of small vessels. A stool guaiac test and palpation for lymphadenopathy, thyroid nodules, breast masses, prostate nodules, and rectal masses are warranted. Relevant history includes degree of trauma, constitutional symptoms, previous history of malignancy, smoking, dietary habits, and exposures. The patient received 800-centigray radiation palliative t herapy to the left femur and was scheduled for outpatient palliative chemotherapy.Ī pathologic fracture occurs in abnormal bone, typically with normal activity or minimal trauma.1 Common causes are osteoporosis, osteomalacia, Paget disease, osteopetrosis, osteogenesis imperfecta, fibrous dysplasia, primary benign tumor, primary malignant tumor, and metastatic tumor. Immunoperoxidase staining suggested primary lung adenocarcinoma. She then underwent repair of the fracture intra-operative femur tissue biopsy showed metastatic poorly differentiated non–small cell carcinoma. The patient’s thigh was splint, and she was admitted to the hospital. ![]() CT scans of the brain, abdomen, and pelvis were negative. A bone scan showed increased uptake in the distal femur only. White blood cell count was 12,000/μL, and erythrocyte sedimentation rate (ESR) was 42 mm/h. Acid-fast bacillus and fungal sputum cultures were negative. Results of a GI panel calcium, phosphorus, alkaline phosphatase, and alpha-fetoprotein levels and serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), and urinalysis results were normal. Scan as a thick-walled cavitary mass (C, arrow). A chest radiograph revealed a 6-cm round mass in the right lower lung with central lucency (B, arrow), clearly defined by a chest CT Rectal examination was unrevealing, and the stool guaiac test was negative.Ī radiograph of the femur showed an aggressive mottled lesion in the distal diaphysis (arrow head) with a pathologic fracture (arrow) (A). Swelling and tenderness were noted in the distal thigh. The edge of the liver was palpable, but there was no ascites or splenomegaly. Breath sounds were decreased in the right lower base. Neck was supple with no thyroid enlargement, and no lymph nodes were palpable. ![]()
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