Metastases of carcinoma in the pagetic bone. A report of two cases.

Two men, aged 68 and 77 years, had metastases of carcinoma in pagetic bones. These cases were initially diagnosed clinically as Paget's sarcoma. Roentgenograms, scintigrams, and bone puncture biopsy specimens (BPBs) of the right scapula and the sacrum, respectively, showed only Paget's disease. However, an additional BPB obtained with the aid of computed axial tomography (CAT) revealed the presence of metastases of lung carcinoma in the right scapula and of a carcinoma of probable prostatic origin in the pagetic sacrum in the other. The observations testify to the usefulness of CAT-directed BPB when Paget's sarcoma is suspected, especially in cases located in the scapula, pelvis, or spine.

Reflex sympathetic dystrophy and early damage of carpal bones.

A 56-year-old woman presented with changes characteristic of the reflex sympathetic dystrophy syndrome (RSDS) but also frank synovitis of the left wrist, an elevated ESR and early damage of the left carpus on radiographs, suggesting septic arthritis. A dynamic scan showed changes characteristic of RSDS. A sample of synovium and bone from the wrist showed non-specific inflammation with partial destruction of cartilage by synovial pannus and involvement of subchondral bone by the inflammatory process. The search for the cause of infection was unsuccessful. Patchy osteopaenia developed 3 months after onset. At the 12 month follow-up, the course of disease was compatible with RSDS and destruction of the carpus had not progressed. Attention is drawn to the difficulty in reaching a precise diagnosis in early stages and the need to exclude infection.