대한흉부영상의학회 Weekly Chest Cases

Case No : 812 Date 2013-05-20

Courtesy of Ji-in Choi, Jae Seung Seo / Chung-Ang University Hospital
Age/Sex 42 / M
Chief ComplaintRoutine follow-up(Past history; abdominal surgery four years ago)

Figure 1
Figure 2

initial chest radiograph

Diagnosis With Brief Discussion

Diagnosis: Bone metastasis from stomach cancer
Radiologic Findings: Initial chest radiograph shows no active lesion in both lungs. Follow up chest radiograph taken on five months later shows diffuse, osteosclerotic or osteoblastic lesions in spine, both scapula and whole ribs.
Whole body bone scan shows diffuse hot uptakes in whole spine, right scapula, whole ribs, both pelvic bones and right femur. Chest CT scan with bone setting view shows diffuse, osteosclerotic or osteoblastic lesions in spine, both scapula and whole ribs. CT guided bone biopsy at Lt. iliac bone was performed, revealing metastatic carcinoma. He had a history of subtotal gastrectomy for advanced gastric cancer (pT3N2M0) four years ago.
Brief Review: The proportion of gastric cancer patients among the annually registered cancer patients in Korea is as high as approximately 20%. Gastric cancer generally metastasizes to the peritoneal membrane, liver, lymph nodes, etc., and it may metastasize to the spleen, adrenalin, ovary, lung, brain and skin.
Bone metastasis generally occurs in patients with prostate cancer, breast cancer and lung cancer, and bone metastasis in gastric cancer patients has been shown to be very rare. Bone metastasis is usually associated with disseminated vascular coagulation, hemolytic anemia and other hematological complications, and the prognosis is very poor.
The spine and pelvis are the most common metastatic sites, due to the presence of red (haematopoietic active) bone marrow in a high amount. The radiographic patterns can be osteosclerotic, mixed, and lytic patterns. It is not generally recommended as a screening method because of poor sensitivity.
The radioisotope bone scan has been the standard method for detection of skeletal metastases. Isotope scanning is more sensitive than radiography for detection of most metastases.
References: 1. Jae Bong Ahn, Tae Kyung Ha, and Sung Joon Kwon. Bone metastasis in gastric cancer patients. J Gastric Cancer 2011 March; 11(1): 38-45
2. L. D. Rybak, D. I. Rosenthal. Radiological imaging for the diagnosis of bone metastasis.Q J NUCL MED 2001;45:53-64
Keywords: Chest wall, Malignant tumor,

No. of Applicants : 60

▶ Correct Answer : 11/60, 18.3%

- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- University of British Columbia , Canada Amr Ajlan
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- All India Institute of medical sciences , India Justin Moses
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- McGill university , Canada Badriya Al-Qassabi
- Dongtan Sacred Heart Hospital , Korea (South) Younghwan Ko
- Chungbuk University Hospital , Korea (South) Yunhee Jang
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Kizawa Memorial Hospital , Japan Yo Kaneko
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio

▶ Correct Answer as Differential Diagnosis : 9/60, 15.0%

- Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- Asan medical center , Korea (South) Hyun Joo Lee
- Asan medical center , Korea (South) Sang Young Oh
- McGill University - Cairo University , Canada Hisham Mikhael
- IRSA La Rochelle France , France Denis Chabassiere
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim

▶ Semi-Correct Answer : 1/60, 1.7%

- Dae-jeon Bohun Veterans Hospital , Korea (South) KI-TAE HAN

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 812 Date 2013-05-20

Discussion

No. of Applicants : 60