Dataset Information

Mistaken Metastasis: Radiation-Induced Rib Fracture Mimicking Malignancy on Computerized Tomography Case Report.

ABSTRACT: A 62-year-old woman with a 40-pack-year smoking history and severe chronic obstructive pulmonary disease with early-stage right upper lobe non-small cell lung cancer (NSCLC) was treated with stereotactic ablative radiotherapy (SABR). Two years after treatment, a surveillance computerized tomography scan showed lesions of the posterior 4th and 5th ribs including expansion of the medulla that was unusual and of concern for possible malignant infiltration. A follow-up magnetic resonance imaging (MRI) scan revealed these lesions to be healing fractures post-radiotherapy. Although generally well tolerated, SABR is known to produce inflammatory and fibrotic changes both in-field and in organs at risk, and rib fractures are a well-established adverse event. MRI has high diagnostic accuracy and sensitivity for rib fractures and was able to rule out malignant spread. This case demonstrates the need for regular follow-up following SABR for early-stage NSCLC, as well as the challenge of interpreting indeterminate post-SABR radiography findings.

SUBMITTER: Esmonde-White C

PROVIDER: S-EPMC10114023 | biostudies-literature | 2023 Jan-Dec

REPOSITORIES: biostudies-literature

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Mistaken Metastasis: Radiation-Induced Rib Fracture Mimicking Malignancy on Computerized Tomography Case Report.

Esmonde-White Caroline C Palma David D Mutsaers Adam A

Case reports in oncology 20230101 1

A 62-year-old woman with a 40-pack-year smoking history and severe chronic obstructive pulmonary disease with early-stage right upper lobe non-small cell lung cancer (NSCLC) was treated with stereotactic ablative radiotherapy (SABR). Two years after treatment, a surveillance computerized tomography scan showed lesions of the posterior 4th and 5th ribs including expansion of the medulla that was unusual and of concern for possible malignant infiltration. A follow-up magnetic resonance imaging (MR ...[more]

PMID: 37092118

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Project description:PurposeIn our conventional image registration workflow, the four-dimensional (4D) CBCT was directly registered to the reference helical CT (HCT) using a dual registration approach within the Elekta XVI software. In this study, we proposed a new HCT-CBCT auto-registration strategy using a previously registered CBCT (CBCTpre) as the reference image and tested its clinical feasibility.MethodsFrom a previous CBCT session, the registered average 4D CBCT was selected as CBCTpre and the HCT-CBCTpre registration vector from the clinician's manual registration result was recorded. In the new CBCT session, auto-registration was performed between the new average 4D CBCT (CBCTtx) and CBCTpre (CBCTpre-CBCTtx). The overall HCT-CBCTtx registration result was then derived by combing the results from two registrations (i.e., HCT-CBCTpre + CBCTpre-CBCTtx). The results from the proposed method were compared with clinician's manually adjusted HCT-CBCTtx registration results ("ground truth") to evaluate its accuracy using a test dataset consisting of 32 challenging registration cases.ResultsThe uncertainty of the proposed auto-registration method was -0.1 ± 0.5, 0.1 ± 1.0, and -0.1 ± 0.7 mm in three translational directions (lateral, longitudinal, and vertical) and 0.0° ± 0.9°, 0.3° ± 0.9°, and 0.4° ± 0.7° in three rotation directions, respectively. Two patients (6.3%) had translational uncertainty > 2 mm (max = 3.1 mm) and both occurred in the longitudinal direction. Meanwhile, the uncertainty of the conventional direct HCT-CBCTtx auto-registration was -0.4 ± 2.6, -0.2 ± 7.4, -1.4 ± 3.6 mm for translations and -0.3° ± 1.2°, 0.0° ± 1.6°, and 0.1 ± 1.1° for rotations. Eleven patients (34.4%) had translation uncertainty > 2 mm (max = 26.2 mm) in at least one direction. Accuracy in translation was improved with the new method, while rotation accuracy stayed in the same order.ConclusionWe demonstrated the feasibility of incorporating prior clinical registration knowledge into the online HCT-CBCT registration process. The proposed auto-registration method provides a quick and reliable starting solution for online HCT-CBCT registration.

Project description:BackgroundPhyllodes tumours (PTs) are fibroepithelial breast tumours, which can be classified as benign, borderline or malignant, according to their histological characteristics. While various huge borderline or malignant PTs have been previously described, a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported. In order that doctors may have a comprehensive understanding of super-giant benign PTs (≥ 20 cm), we also performed a literature review to summarize the clinical features, differential diagnosis, and treatment of this disease.Case summaryA 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass, measuring approximately 30 cm × 25 cm × 20 cm that was first noticed 1 year previously. A region of skin ulceration and necrosis (20 cm × 15 cm) was observed on the lateral side of the mass. Computed tomography (CT) of the chest revealed a pulmonary nodule, which initially suggested a diagnosis of metastasis. CT showed that the boundaries between the pectoralis major and the mass were blurred, which was presumed to be due to tumour invasion. However, two core needle biopsies of the mass showed no evidence of malignancy. Following these results, the tumour was removed by mastectomy of the right breast. Interestingly, postoperative pathology finally proved the diagnosis of a benign PT. After 1 year of follow-up, wedge resection of the small pulmonary nodule was performed, and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer. The patient recovered very well without any postoperative treatment.ConclusionThis case is unique in that the giant breast mass initially mimicking a malignant clinical presentation was eventually pathologically confirmed to be a benign PT, which misled the diagnosis and complemented the atypical features of benign PTs. The pathological and immunohistochemical results were important in the differential diagnosis. In addition, total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs, especially in large breast masses. In the literature, almost one-half of super-giant benign cases were thought to be malignant tumours before surgery. This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.

Dataset Information

Mistaken Metastasis: Radiation-Induced Rib Fracture Mimicking Malignancy on Computerized Tomography Case Report.

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Mistaken Metastasis: Radiation-Induced Rib Fracture Mimicking Malignancy on Computerized Tomography Case Report.

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