Bone metastases from squamous cell carcinoma of the head and neck.

BACKGROUND AND OBJECTIVES: Carcinoma of the head and neck is an uncommon primary source of bone metastases. The increasing duration of survival of these patients, however, increases the probability of late bone involvement. The objective was to identify the frequency, clinical presentation, and clinical course of metastatic disease to bone from head and neck primaries. METHODS: A retrospective review was accomplished of the radiographs and nuclear medicine studies for 363 cases of squamous cell carcinoma of the head and neck for whom radiologic studies had been performed. For those with identified bone involvement, a chart review was performed to identify clinical presentation, disease course, and outcome. RESULTS: Only approximately 1% of these patients had clinically demonstrable bone metastases. Eight sites of bone involvement were identified in five patients, including three pelvic, two femoral, and one each humeral, rib, and thoracic spine lesions. All lesions were purely lytic with moth-eaten or permeative borders. Time from primary tumor diagnosis to identification of metastatic disease ranged from being present at diagnosis to a maximum 3.5 years later. Time from identification of metastatic disease to patient death was no greater than 8 months. CONCLUSIONS: Despite the increasing overall survival of patients with these carcinomas, distant bone metastases are infrequent, but should be considered a possibility in any patient with a concurrent or past diagnosis of head and neck carcinoma. The very short time from discovery of bone dissemination to death in most of these patients should be taken into consideration when contemplating operative intervention.

Fibroma of tendon sheath of the infrapatellar fat pad.

We report on a 13-year-old boy who was found to have a fibroma of the tendon sheath associated with the patellar tendon and within Hoffa's fat pad of the knee. This benign tumor has never been described in this location previously. The MRI characteristics are correlated with the histologic findings.

The value of gallium imaging after therapy for Hodgkin's disease.

BACKGROUND: Although it is used widely, the value of gallium imaging in managing Hodgkin's disease remains unclear. METHODS: A retrospective review of gallium imaging and treatment outcome in 60 patients with Hodgkin's disease treated between January 1990 and July 1995 was conducted. The minimum follow-up was 1 year. RESULTS: Based on gallium imaging, 46 patients were in complete remission (CR) after initial treatment, 10 were in partial remission (PR), and 4 had persistent or progressive disease (NR). Ten of 29 patients (34%) with gallium CR after chemotherapy subsequently recurred, compared with no recurrences in 17 patients receiving initial radiotherapy or combined chemoradiation. Eight of ten patients received further therapy after gallium PR, and nine patients remained disease free at last follow-up. Survival did not differ in patients achieving a gallium CR or PR. CONCLUSIONS: Gallium-67 imaging may help confirm the presence of active Hodgkin's disease, but was unreliable in defining disease remission after chemotherapy in this study population. Patients with a gallium PR may still have a good prognosis after additional therapy.