Skeletal metastases - from primary transitional cell carcinoma of bladder

Case contributed by Dr James Sheldon

Presentation

Ankle pain

Patient Data

Age: 68 years
Gender: Male

Mottled appearance of the distal tibia with periosteal reaction.

This is an aggressive lesion with ddx of osteomyelitis vs malignant bone tumor (metastases most likely).

There is a diffuse mottled and permeative process involving most of the tibial shaft extending to the plafond. Diffuse periosteal reaction along cortex of the tibial shaft.

A more focal 5.5 cm long midshaft lesion expanding the medullary cavity and scalloping endosteum is suspected. There is a bony exostosis in the dorsal proximal tibial shaft.

Cortical disruption at anterior aspect of tibial plafond compatible with minimally displaced pathological fracture. Adjacent soft tissue stranding.

 

Case Discussion

The lesion was biopsied.

Pathology:

The sections show features of metastatic poorly differentiated carcinoma, invading in-between the bony trabeculae.

The tumor forms nests, surrounded by desmoplastic stroma. The tumor cells have enlarged nuclei, prominent nucleoli and moderate amounts of eosinophilic cytoplasm. No evidence of lymphovascular invasion is seen.

The tumor morphology is similar to that seen in the previous bladder biopsy

Diagnosis: Left tibial bone bx: Metastatic poorly differentiated carcinoma, consistent with bladder primary.

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Case information

rID: 34079
Published: 3rd Feb 2015
Last edited: 27th Jun 2017
Inclusion in quiz mode: Included

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