Solitary metastases from colorectal carcinoma in the absence of hepatic or pulmonary metastases are rare. These can have a diverse imaging appearance, particularly after chemotherapy. It is important identify patients with solitary skeletal metastases, as they have a better prognosis than those with multiple skeletal or visceral metastases. We describe an unusual case of a solitary metastasis to the femur in a case of colon carcinoma that went undiagnosed and later presented with imaging features of osteogenic sarcoma.
Adult ; Bone Neoplasms/diagnosis/radiography/secondary ; Carcinoma/*diagnosis/pathology/radiography ; Colorectal Neoplasms/*diagnosis/pathology/radiography ; Female ; Femur/radiography ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Tomography, X-Ray Computed

Metastases to intramammary nodes have been shown to be an independent predictor of poor outcome in patients with breast cancer, such as axillary lymph node metastases. The detection and accurate characterization of these nodes preoperatively is thus crucial for the staging and planning of treatment for breast carcinoma, particularly in cases with axillary lymph node negative disease as it upgrades the disease staging. We herein report the first case where we detected an intra-mammary node on specimen MRI after the primary pathological gross specimen evaluation failed to detect the node.
Axilla ; Breast Neoplasms/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Female ; Humans ; Lymph Nodes/*pathology ; Lymphatic Metastasis ; Magnetic Resonance Imaging/*methods ; *Mastectomy ; Middle Aged ; Neoplasm Staging ; Retrospective Studies

Objective: Magnetic resonance imaging (MRI) has become an integral part of pre-operative work up of patients with early cervical cancer. It has superior soft tissue delineation and therefore useful in evaluation of parametrial, cervical stromal, and regional lymph node involvement. In 2018, FIGO also incorporated radiology into staging of carcinoma cervix, with upstaging to stage III based on radiological involvement of lymph nodes. However, there is scant data available from low-and middle-income countries’ regarding the diagnostic performance of MRI in patients with operable cervical cancer. Therefore, this retrospective study was planned. Methods: A retrospective review of electronic medical records of all patients who underwent radical surgery for carcinoma cervix between 2013–2018 at our institute and had a pre-operative MRI. Diagnostic performance of MRI with respect to assessment of tumor size, cervical stromal invasion, parametrial, vaginal and lymph nodal involvement was evaluated using sensitivity, specificity, positive and negative predictive values (PPV, NPV), positive and negative likelihood ratios (PLR, NLR) and false negative and false positive rates (FNR, FPR). Final histopathological report was considered as the gold standard. Results: Total 79 patients who underwent surgery for early cervical cancer and had pre-operative MRI, were included in the study. For parametrial involvement MRI showed high sensitivity (100%) with moderate specificity (71.8%) but high FPR (28.2%) and low PPV (4.7%). For cervical stromal involvement MRI revealed moderate sensitivity (65.6%) with high specificity (100%) but high FNR (34.4%) and low NPV (15.4%). Tumor size assessment on MRI had 85.5% concordance with tumor size on gross pathological examination. For pelvic lymph node and vaginal involvements, MRI showed poor sensitivity; 14.3%, 25%, respectively. Conclusion In patients with operable cervical cancer MRI pelvis cannot replace a well conducted clinical examination to assess loco-regional disease spread. Clinical examination still plays a major role in triaging patients for radical surgery or radical radiotherapy. We should be cognizant of the effects of stage migration of cervical cancer based on radiology with resultant possibility of change of management.