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Patellar Metastasis from a Squamous Cell Carcinoma of the Larynx

Eulji Hospital, Eulji University School of Medicine Seoul, 139-231, Korea
Chung-Ang University Hospital Seoul, 120, Korea

Metastatic tumors of the patella are rare. We report a case of patellar metastasis from laryngeal carcinoma presenting as a monoarticular arthritis. This is the first case, to our knowledge, of patellar metastasis from squamous cell carcinoma of the larynx illustrated with MR images.

A 65-year-old man presented to a physician with left knee pain of 3 months' duration. The left knee was swollen, warm, red, and tender. Initial chest radiography showed old tuberculosis of both upper lobes and multiple nodules of various sizes in both lungs. Lateral radiography of the left knee showed expansive and permeative destruction of the patella in addition to an effusion (Fig. 3A). The fluid was aspirated from the left knee joint. It was viscous and straw-colored and contained 170 x 10⁶ WBC/1 and 90 x 10⁶ RBC/1. A ^99mTc-methylene diphosphonate bone scan showed increased uptake over the left patella and left iliac bone. MR imaging was performed with a 1.5-T Signa (General Electric Medical Systems, Milwaukee, WI). On T1-weighted sagittal imaging (Fig. 3B), the patella revealed expansion and homogeneous low signal intensity. On T2-weighted sagittal imaging (Fig. 3C), the periphery of the patella revealed high signal intensity and the center revealed low signal intensity. There was soft-tissue extension of the lesion. On gadolinium-enhanced T1-weighted imaging (Fig. 3D), the tumor enhanced diffusely except for the center of the patella where the low signal intensity had been found on T2-weighted imaging.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A. —65-year-old man with pain in left knee. Lateral radiograph of knee shows expansive permeative destruction of patella.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B. —65-year-old man with pain in left knee. Sagittal T1-weighted MR image (TR/TE, 500/12) shows homogeneous low-signal-intensity patella. Cortex is thinned and interrupted along circumference.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C. —65-year-old man with pain in left knee. Sagittal T2-weighted MR image (200/80) shows heterogeneous low-signal-intensity focus in high-signal-intensity background of patella.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D. —65-year-old man with pain in left knee. Sagittal gadolinium-enhanced T1-weighted MR image (500/13) shows patella diffusely enhancing, except in center. Soft-tissue lesions are enhanced also.

The patient had a history of a laryngeal carcinoma 1 year before this admission to our hospital. The punch biopsy of the patella revealed metastatic squamous cells in the bony trabeculae. The specimen was the same as the tissue from the patient's laryngeal carcinoma.

Metastases of the patella are rare [1,2,3,4]. The clinical presentation of patellar metastasis mimics septic arthritis or tuberculous arthritis of the knee, leading to diagnostic confusion. The findings of the patellar metastases in simple radiography are osteolytic lesion, bone fractures, soft-tissue mass, blastic changes, periostitis, and an abnormal adjacent long bone [1]. In our patient, conventional radiography revealed expansive permeative destruction of the whole patella. T1-weighted MR images revealed the expansive destruction of the patella with low signal intensity of the marrow. T2-weighted MR images showed a heterogeneous low-signal-intensity focus in a high-signal-intensity background. Unfortunately, we performed punch biopsy only at the patella and the fragments did not contain the central portion that showed a low signal intensity on T2-weighted imaging. The expansive nature of the lesion helped indicate the diagnosis of a tumorous condition.

References

1. Pauzner R, Istomin V, Segal-Lieberman G, Matetzky S, Farfel Z. Bilateral patellar metastases as the clinical presentation of bronchogenic adenocarcinoma. J Rheumatol 1996;23:939 -941[Medline]
2. Aktas S, Demiral H, Bilgi S, Caglar T, Calpur OU. Patellar metastasis from a lung epidermoid carcinoma. Yonsei Med J 1998;39:474 -477[Medline]
3. Sur RK, Singh DP, Dhillon MS, Gupta BD, Murali B, Sidhu R. Patellar metastasis: a rare presentation. Br J Radiol 1992;65:722 -724[Abstract/Free Full Text]
4. Gall EP, Didizian NA, Park Y. Acute monarticular arthritis following patellar metastasis: a manifestation of carcinoma of the lung. JAMA 1974;229:188 -189[Abstract/Free Full Text]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Choi, Y. S. Articles by Song, I. S. Search for Related Content PubMed PubMed Citation Articles by Choi, Y. S. Articles by Song, I. S. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?