question about possibe bone island

[CareyG]

Thanks for this chance to ask someone on the front lines.

Wanted your feedback on the following situation.  A close relative, 45, stage 2A, total hysterectomy, 6 rounds carbo taxol.  Tolerated surgery and chemo very well. Before the surgery the CA125 was in the low 90's and jumped right down to the 20's after surgery and is now at around 5.  The surgery was performed by one of the top gyn-oncs on the east coast and while there was extensive endo scar tissue, there was no evidence of disease at the end of surgery.  

The follow up CT scan at the end of treatment showed all clear except that it discovered a sacral bone abnormality.  The doc said possible a "bone island" but they want a bone scan because this abnormality did not appear on the MRI that she had a week before her surgery.  This is only about 5 months ago.

The doc said he had never seen cancer metastisize to the bone from ovarian and the nurse said she had only seen it twice [out of thousands of patients] and never at stage 2 disease.

I am hoping to get some feedback from you about how to reassure her.   The doc and nurse practitioner say they think it is probably nothing.  He also said the CA125 would most likely have been elevated if this bone abnormality had been of concern.

This bone thing didn't show up on the MRI only 5 or so months earlier and I was wondering how fast can these bone islands or benign bone conditions develop?  How could any cancer develop in the bone while she was undergoing chemo for the past 5 months?

The doc said he wasn't sure the MRI was the best imaging tool for bone and thought it possible the CT picked it up clearer.  I was also wondering if the large cysts could have obscured the MRI from picking up the bone abnormality on the sacrum.

We are so encouraged by her overall health and excellent progress and test results, I just want to know if I can get an opinion from you about what you think it might be?

[Annekathryn Goodman, M.D.]

Hi Carey
yes, MRI have differnt settings depending on the reason you get it. there are bone MRIs and soft tissue MRIs. So if you had a sift tissue MRI, it may not have been sensitive enough to pick up bone lesions becasue they were not looking at the bones
best wishes

[CareyG]

Not to be a pest, but I think you might have missed my last question on this topic, so I am reposting it

"I guess it is possible the lesion was there 5 months ago and the MRI missed it?  When we talk to the doctors, sometimes I forget questions or I feel I have to streamline my questions, it really helps to be able to ask you this thanks.

So an MRI 5 months ago could have missed what the CT scan found last week?   "

THANKS

CareyG

[CareyG]

Thanks Dr. Goodman, thats interesting.  I guess it is possible the lesion was there 5 months ago and the MRI missed it?  When we talk to the doctors, sometimes I forget questions or I feel I have to streamline my questions, it really helps to be able to ask you this thanks.

So an MRI 5 months ago could have missed what the CT scan found last week?  

[Annekathryn Goodman, M.D.]

yes! I suspect it was there 5 months ago
don't apologize, thank you for your questions
best wishes

[CareyG]

Thanks Dr. Goodman.

Just so I understand, - it true to say there are several benign reasons a bone abnormality could appear within a 5 month period that have nothing to do with the cancer?  The only question is how could this develop between the time of her pre surgical MRI five months ago and her post treatment CT scan.  Have you ever seen something like that?

Thanks for being patient answering all these questions. It is very much appreciated!

[Annekathryn Goodman, M.D.]

Hi there
in answer to your questions
- Would the CA125 definitely be elevated if this were cancer? yes
- Could the stress on the bones from the carbo taxol have caused this lesion to appear?
no
-Is it possibe the MRI missed it because there were cysts occluding it? no
-bone mets are late event. There is usually lots of other tumors present when bone is involved by cancer

[CareyG]

Thanks for your quick response Dr. Goodman.  I appreciate the information and your confirmation that it would be very unusual for ovarian cancer to metastasize to the bone.  Hope you will indulge a few more questions I have been unable to find answers to on the internet.

Would the CA125 definitley be elevated if this were cancer?

Could the stress on the bones from the carbo taxol have caused this lesion to appear?

Is it possibe the MRI missed it because there were cysts occluding it?

When you say "in the abscense of other metastases, do you mean other appearences of cancer on the scan or as evidenced by teh CA125.  Hers is now in the range of 5.4

Thank you again in advance it was reassuring to hear that you agreed it would be unlikely that this would be a spread of the cancer.   Thanks for your response

[Annekathryn Goodman, M.D.]

Hi There,
It would be very unusual to have an ovarian cancer travel to the bone in the absence of otehr metastases. I would recommend that your relative get an orthopedic consultation. I have pasted below information on bone islands from the emedicine website.
best wishes

Background: A bone island, also known as an enostosis, is a focus of compact bone located in cancellous bone. This is a benign entity that is usually found incidentally on imaging studies; however, the bone island may mimic a more sinister process, such as an osteoblastic metastasis (eg, from prostate cancer).


Pathophysiology: Although the exact etiology of bone islands is not clear, they are almost certainly developmental in nature, likely representing cortical bone that has failed to undergo medullary resorption during the process of endochondral ossification. Histologically, bone islands are intramedullary foci of normal compact bone with haversian canals and "thorny" radiations that merge with the trabeculae of surrounding normal cancellous bone.


Frequency:


In the US: The exact frequency is unknown; however, reports have described a frequency of 1-14%.
Mortality/Morbidity: Bone islands are considered benign lesions without associated morbidity or mortality.

Race: No racial predilection is recognized.

Sex: The prevalence of bone islands is approximately equal in men and women.

Age: Bone islands are common in the adult population and rare in children.

Anatomy: Bone islands are rare in the calvaria, a fact that lends additional support to the theory of a minor endochondral defect as a potential etiology. Bone islands can be found in any osseous site; however, they are most commonly identified in the pelvis, long bones, ribs, and spine.

Clinical Details: Bone islands are almost invariably asymptomatic lesions that do not result in laboratory abnormalities. A single case report in the English literature describes a patient with a symptomatic, histologically proven bone island of the tibia (symptoms resolved following curettage). Another report described an enlarging mandibular bone island that resulted in inclination of the adjacent teeth of a young girl.

Preferred Examination: Bone islands usually are found incidentally on imaging studies and demonstrate characteristic radiographic findings.

[CareyG]

Thanks for this chance to ask someone on the front lines.

Wanted your feedback on the following situation.  A close relative, 45, stage 2A, total hysterectomy, 6 rounds carbo taxol.  Tolerated surgery and chemo very well. Before the surgery the CA125 was in the low 90's and jumped right down to the 20's after surgery and is now at around 5.  The surgery was performed by one of the top gyn-oncs on the east coast and while there was extensive endo scar tissue, there was no evidence of disease at the end of surgery.  

The follow up CT scan at the end of treatment showed all clear except that it discovered a sacral bone abnormality.  The doc said possible a "bone island" but they want a bone scan because this abnormality did not appear on the MRI that she had a week before her surgery.  This is only about 5 months ago.

The doc said he had never seen cancer metastisize to the bone from ovarian and the nurse said she had only seen it twice [out of thousands of patients] and never at stage 2 disease.

I am hoping to get some feedback from you about how to reassure her.   The doc and nurse practitioner say they think it is probably nothing.  He also said the CA125 would most likely have been elevated if this bone abnormality had been of concern.

This bone thing didn't show up on the MRI only 5 or so months earlier and I was wondering how fast can these bone islands or benign bone conditions develop?  How could any cancer develop in the bone while she was undergoing chemo for the past 5 months?

The doc said he wasn't sure the MRI was the best imaging tool for bone and thought it possible the CT picked it up clearer.  I was also wondering if the large cysts could have obscured the MRI from picking up the bone abnormality on the sacrum.

We are so encouraged by her overall health and excellent progress and test results, I just want to know if I can get an opinion from you about what you think it might be?