Mini Review

A Case Report of Pubic Bone Metastasis from Bladder Cancer Mimicking Osteitis Pubis

Ya-Wen Chuang1, Chien-Chin Hsu2, Chin-Chuan Chang1, Chia-Yang Lin1, Ying-Fong Huang1,3 and Yu Chang Tyan3,4,5,6,7*
1Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Taiwan
2Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
3Department of Medical Imaging and Radiological Sciences, College of Health Science, Kaohsiung Medical University, Taiwan
4Department of Infectious Disease and Cancer Research, Kaohsiung Medical University, Taiwan
5Department of Medical Science and Technology, National Sun Yat-sen University, Taiwan
6Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
7Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan


*Corresponding author: Yu Chang Tyan, Department of Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan

Published: 31 Jul, 2017
Cite this article as: Chuang Y-W, Hsu C-C, Chang C-C, Lin C-Y, Huang Y-F, Tyan YC. A Case Report of Pubic Bone Metastasis from Bladder Cancer Mimicking Osteitis Pubis. Clin Oncol. 2017; 2: 1319.

Abstract

Most symmetric radiotracer accumulation in the skeleton found in bone scintigraphy is thought to be non-specific or benign cause. Solitary symmetric bone metastasis is rare and often misinterpreted. Other image modalities or biopsy are usually needed to differentiate malignant metastasis from benign cause. The authors report a case of bladder cancer with pubic bone metastasis. The bone scan showed symmetric uptake in bilateral pubic bones mimicking the typical appearance of osteitis pubis. However, the pelvic CT scan showed bone metastasis to symphysis pubis.
Keywords: Bone scintigraphy; Bone metastasis; Bladder cancer; Osteitis pubis


Introduction

Osteitis pubis (also known as the pubic symphysitis) is a painful, inflammatory, noninfectious condition that involves the periosteum, bonecartilage, and ligament us structures in the symphysis pubis. It can result from several causes such as genitourinary or gynaecological surgery in older individuals [1]. One of these is mechanical strain, either from a single major event or from repetitive micro trauma, such as from running [2-7].


Case Report

A 61-year-old female patient had end stage renal disease and received hemodialysis for 5 years. Due to painless hematuria, she came to our hospital for help and transitional cell carcinoma was diagnosed. Therefore, she underwent bilateral nephrourectomy, radical cystectomy and pelvic lymph node dissection as a treatment [8].


Figure 1

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Figure 1
The symmetrically increased radioactivity insymphysis pubis and adjacent superior pubic rami, mimicking the typical appearanceof symphysitis pubis.

Figure 2

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Figure 2
The pelvic CT scan showed bone destruction of the symphysis pubis withadjacent soft tissue lesion.

Discussion

One year later, Tc-99mMDP bone scanand pelvic CT scan were arranged for her follow-up survey. The whole body bonescan was performed at 3 hours after the injection of 740MBq (20 mCi) Tc- 99m methylene diphosphonate (MDP). The symmetrically increased radioactivity in symphysis pubis and adjacent superior pubic rami, mimicking the typical appearanceof symphysitis pubis (Figure 1).
The pelvic CT scan showed bone destruction of the symphysis pubis withadjacent soft tissue lesion (Figure 2). Metastatic disease is considered. In summary, this case illustrates the potential pitfalls of misinterpreting solitary symmetric bone metastasis as benign cause. Careful attention to the clinical and radiographic presentation is important to avoid this misdiagnosis.


Acknowledgments

This work was supported by Research Grants MOST 103-2320- B-037-025 from the Ministry of Science and Technology, KMUTP105E12, KMU-TP105PR06, KMU-M1060289 from Kaohsiung Medical University, and NSYSUKMU106-P011 from NSYSU-KMU Research Project, Taiwan.


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