How to Know if You Have Knee Joint Cancer
Radiol Instance Rep. 2014; 9(one): 890.
Knee hurting and swelling: An atypical presentation of metastatic colon cancer to the patella
Bethany Gasagranda
aDepartment of Radiology at the Allegheny General Infirmary/Temple University School of Medicine, Pittsburgh PA
Kimberly Leeman
bDepartment of Radiology at the Academy of Pittsburgh Medical Center, Pittsburgh PA
Matthew T. Heller
bDepartment of Radiology at the University of Pittsburgh Medical Centre, Pittsburgh PA
Abstract
Knee joint pain is a common reason for a patient to seek medical evaluation. Of the many causes of knee pain, malignancy is ane of the least common. When malignancy is the etiology of the pain, it is normally due to a primary tumor of the osseous structures or soft tissues of the knee joint joint. Metastatic disease involving the articulatio genus is uncommon, with few cases reported in the literature. Of these reported cases, metastatic colon cancer is exceedingly rare. However, in a patient with new onset knee pain and the proper clinical history, metastatic disease should be considered as a potential explanation of symptoms. We study a case of knee pain and swelling due to metastatic colon cancer to the patella.
Case report
A 51-yr-old male person presented with intermittent dull hurting and swelling in the patellar region of his right knee for the past three–iv weeks. He denied injury, fever, or change in his activity level. Vital signs were normal, and the physical test was pregnant only for mildly decreased range of motion. Laboratory assay was unrevealing. The patient'southward by medical history included hypertension and colon cancer that was treated with surgery and chemotherapy. An aspiration of the right knee joint revealed a minor volume of clear xanthous fluid and provided cursory symptomatic relief. After i week, the swelling returned and the patient had progressive difficulty extending and flexing his human knee. The patient was then referred for a magnetic resonance imaging (MRI) exam. This revealed a large, lobulated mass centered inside the patella simply extending into the joint infinite (Fig. one).
MRI of the knee shows extensive tumor (arrowheads) in the soft tissues along the ventral aspect of the distal femur, within the articulation infinite, and involving the patella. The tumor showed heterogeneous enhancement following contrast administration. A. Sagittal T1-weighted MR of the knee. B. Sagittal T2-weighted, fatty-saturated MR of the knee joint. C. Centric T1-weighted, fatty-saturated MR of the articulatio genus. D. Axial T1-weighted, fat-saturated MR of the knee after administration of intravenous dissimilarity fabric.
Needle biopsy revealed metastatic adenocarcinoma (Effigy 2, Figure 3).
Resection specimen. The specimen consists of complete resection of the knee (distal femur, proximal tibia, patella). Extensive tumor in the soft tissues resulted in formation of intestinal-similar glands.
A. Depression-power hematoxylin and eosin stain of soft-tissue mass arising from the patella demonstrates glands and areas of "dirty" necrosis, characteristic of metastatic gastrointestinal adenocarcinoma. B. Low-power keratin stain is positive for epithelial cloth, consistent with adenocarcinoma. C. Depression-power CDX2 stain is positive, consistent with tumor of lower alimentary canal/colonic origin.
The patient underwent resection of the distal right femur, proximal tibia, and knee articulation followed by reconstruction with distal femoral replacement and hinge human knee arthroplasty. During resection, it was noted that the patella was found to be completely destroyed by tumor, and in that location was spread of the tumor to the retinaculum of the knee joint. The patient's recovery was uneventful.
Discussion
Articulatio genus pain is a common ailment affecting the general population. Primary-care, emergency, and sports-medicine physicians are faced with deciphering the myriad causes of genu hurting and swelling. Nigh cases of knee pain are due to contradistinct biomechanics and inflammatory etiologies and tin can exist treated conservatively. In cases of failed bourgeois management, avant-garde imaging and reconstructive surgery are often indicated.
Fortunately, malignancy is a rare cause of articulatio genus pain; specifically, malignancies involving the patella are uncommon and are usually due to primary os tumors such equally osteosarcoma (1). More commonly, beneficial neoplasms and tumor-like atmospheric condition account for 70–90% of primary patellar lesions (2); examples include chondroblastoma, bone cysts, giant cell tumors, and gout (1, 3). Metastatic disease involving the patella is fifty-fifty less common than primary malignant tumors (four). A plausible explanation for the relative scarcity of patellar metastases stems from the patella's being a sesamoid os with a poor claret supply and distal location (five). Sporadic cases of patellar metastases from various principal tumors, such as melanoma, lung, renal cell carcinoma, and laryngeal carcinoma, have been reported in the literature; most of these were due to lung cancer (6, 7, 8, 9). Metastatic colon cancer affecting the patella is exceedingly rare; in fact, during the twenty-yr menstruum from 1969 to 1989, in that location were no reported cases in the literature (10). To our knowledge, there have only been two reported cases of adenocarcinoma of the rectum and two reported cases of adenocarcinoma of the colon that take metastasized to the patella (ix, 11).
Radiographic features that raise concern for malignancy involving the patella include osteolytic or osteoblastic permeation or destruction of the cortex, periosteal reaction, and soft-tissue mass. CT and MRI are often useful for further label and facilitate assessment of the soft tissues. Identification of a soft-tissue component in the muscle or joint space is highly suggestive of malignancy, especially in the setting of heterogeneous enhancement of the mass. While in that location are no specific imaging features that are pathognomonic for a metastatic lesion involving the patella, this differential consideration should exist entertained in a patient with the proper history who presents new-onset human knee pain.
Acknowledgment
The authors would like to thank Dr. Alka Palekar from the Section of Pathology.
Footnotes
Published: February 22, 2014
References
1. Kransdorf MJ, Moser RP, Jr., Vinh TN, Aoki J, Callaghan JJ. Primary tumors of the patella. A review of 42 cases. Skeletal Radiol. 1989;eighteen:365–371. [PubMed] [PubMed] [Google Scholar]
ii. Singh J, James SL, Kroon HM, Woertler Chiliad, Anderson SE, Jundt One thousand, Davies AM. Tumour and tumour-like lesions of the patella—a multicentre experience. Eur Radiol. 2009 Mar;nineteen:701–712. [PubMed] [PubMed] [Google Scholar]
iii. Mercuri M, Casadei R, Ferraro A, de Cristofaro R, Balladelli A, Picci P. Tumours of the patella. Int Orthop. 1991;15:115–120. [PubMed] [PubMed] [Google Scholar]
4. Ehara South, Khurana JS, Kattapuram SV, Rosenberg AE, el-Khoury GY, Rosenthal DI. Osteolytic lesions of the patella. AJR Am J Roentgenol. 1989 Jul;153:103–106. [PubMed] [PubMed] [Google Scholar]
5. Benedek TG. Lysis of the patella due to metastatic carcinoma. Arthritis Rheum. 1965 Aug;viii:560–567. [PubMed] [PubMed] [Google Scholar]
six. Meddeb N, Hamza S, Moalla M, Siala M, Sellami S. [Patelar metastasis of primary lung cancer] Rev Pneumol Clin. 2003 Jun;59:176–178. [PubMed] [PubMed] [Google Scholar]
7. Jaeger HJ, Kruegener GH, Donovan AG. Patellar metastasis from a cancerous melanoma. Int Orthop. 1992;xvi:282–284. [PubMed] [PubMed] [Google Scholar]
8. Choi YS, Yoon YK, Kwak HY, Song IS. Patellar metastasis from a squamous prison cell carcinoma of the larynx. AJR Am J Roentgenol. 2000 Jun;174:1794–1795. [PubMed] [PubMed] [Google Scholar]
9. Saglik Y, Yildiz Y, Basarir K, Tezen E, Guner D. Tumours and tumour-similar lesions of the patella: a report of eight cases. Acta Orthop Belg. 2008 Jun;74:391–396. [PubMed] [PubMed] [Google Scholar]
10. Urvoy P, Mestdagh H, Butin E, Lecomte-Houcke Yard, Maynou C. Patellar metastasis from a large bowel adenocarcinoma. Acta Orthop Belg. 1993;59:409–411. [PubMed] [PubMed] [Google Scholar]
xi. Griener B, Muller-Farber J. Patellar metastasis of colon carcinoma. A rarity in differential diagnosis of acute knee pain. Case written report. Unfallchirurg. 2001 Aug;104:778–781. [PubMed] [PubMed] [Google Scholar]
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838750/
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