Husband hurt his back while picking up a heavy bag. Said it felt like sciatica. Went to his primary and she ordered an x-ray. Then he was referred to a spine specialist to f/u on the x-ray. She was not that impressed w/the x-ray so ordered an MRI of lower back. Got the results of the MRI which indicates metastases: 1. Large destructive metastasis involving the S1 segment of the sacrum with soft tissue component extending anteriorly. 2. Several other metastatic lesions involving the iliac wings as well as the L3 and L5 vertebral bodies. Questionable "metastasis versus hemangiomata in the T12 vertebral body. 3. These lesions are from an unknown primary malignancy. While body bone scan should be considered.
Discussed w/PCP and she was perplexed. Nothing to suggest a primary site as husband is not in excruciating pain, blood work has been normal which he gets yearly and every 4 months, prostate exam was normal, nonsmoker/nondrinker. He is 65 years old. He was diagnosed with hemangiomata in the past in his liver as well as on the lower spine years ago.
He will get the bone scan. What is your opinion on this?
Reply # - September 6, 2013, 09:38 AM
Reply To: BONE METS
Hello and welcome to Grace. I'm sorry your husband and you are going through this very confusing diagnosis period. As far as a primary site it's unusual for there not to be evidence of a primary tumor but not rare. We have had a few people on Grace in that situation.
Edited out piece of uncertain info in favor of expert input.
I hope you get answers quickly. Waiting really is the hardest part. After you get answers your able to make a plan and things will settle down.
Janine
forum moderator
Reply # - September 6, 2013, 11:52 AM
Reply To: BONE METS
I'm sorry to hear of these developments and the current uncertainty.
What usually follows in this situation is a series of CT scans, such as chest, abdomen, and pelvis, potentially combined with a PET scan, to look for other nodules/masses that would fit with a pattern of spread to bone. A rectal exam of the prostate isn't conclusive in ruling out prostate cancer, so a serum PSA is also appropriate to check. Sometimes an upper and lower endoscopy are done in part of this workup, particularly if the scans don't give any likely clues of the origin or suggest a cancer in the esophagus, stomach, bowel, etc.
A biopsy is ultimately required to confirm cancer, and the appearance of the cells under the microscope also typically give a good clue for the origin of the cancer.
Good luck in getting more information and developing a plan soon.
-Dr. West
Reply # - September 6, 2013, 01:16 PM
Reply To: BONE METS
Thank you for the info ~ there is one more question ~ what is your feeling of this being just hemangiomatas?
Reply # - September 6, 2013, 01:51 PM
Reply To: BONE METS
If you're referring to liver hemangioma that's a benign process that wouldn't cause bone destroying metastases as you describe in your first post. Here's is a description of that disease from Mayo Clinic, http://www.mayoclinic.com/health/liver-hemangioma/DS01125