Characteristic Bone Lesions in Post-Irradiated Carcinoma of the Cervix

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Abstract
Although Metastases to bone from carcinoma of the cervix are considered unusual, they do occur and present in a characteristic fashion which is worth noting because of the diagnostic appearances on the roentgenogram. Frequently the primary lesion is controlled, although distant bone metastases are present but not appreciated. In a recent review of our cases of carcinoma of the cervix, bone metastases were encountered more frequently than radiation osteosclerosis. Radiographic differential diagnosis is critical to management and can be made with little difficulty once the features are appreciated. These film findings have not been adequately documented in the English literature. Review of the Literature For an entity which is considered uncommon, it is curious how often bone metastasis in carcinoma of the cervix has been documented in the world literature (Table I). The earliest recorded examples date back to 1893, when Albers-Schönberg (1) reported 5 cases of skeletal involvement encountered among 564 patients with cervical carcinoma. During the first thirty years of the present century, a number of case reports appeared either in statistical reviews of the problems and causes of death in carcinoma of the cervix or in general descriptive articles of bone metastases by pathologists, listing the various sites of the primary tumor. The first adequate radiographic evidence of bone metastases in carcinoma of the cervix was recorded in 1932 by Philipp (25), demonstrating the various modes of spread and appearance of the bony lesions. The gross pathologic skeletal invasion is well correlated with the x-ray findings in some instances. In the following decade, sporadic case reports continued to appear, stressing the unusual features of bone metastases in carcinoma of the cervix because of their rarity. In 1940, Norgaard (21) in a very lucid presentation again elaborated upon the problems and unique manner of appearance of some of the bony metastases in cervical cancer. The films of his 3 cases illustrate only some of the points to good advantage. In more recent years, Drescher (9) has reviewed one of the largest experiences with carcinoma of the cervix (2,132 cases) from the point of view of metastases. The incidence of bone metastases was found to be 1.2 per cent and radiographs of some of the 31 reported cases are shown. In perusing the literature, it is apparent that most of the documented cases are in foreign journals, with few well recorded accounts in American or English publications. The best articles (9, 21) to date are in German journals, in which some of the interesting aspects of these metastases are well demonstrated. No attempt will be made to review bone necrosis occurring following the treatment of carcinoma of the cervix, since this has been done in a number of comprehensive articles (4, 12, 15). Presentation of Cases

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