[tetractys]

Can physical trauma / stress produce lytic lesions?

by tetractys on Thu Sep 20, 2018 4:08 pm

My mom (59, white female) has been walking on an injured leg for the past few months, without letting it rest long enough to heal. She originally sprained her hip flexor and abductor muscles and kept walking on the leg because she had to work, making the injury to the leg worse. She finally went to an ER yesterday, mainly to get an official diagnosis for work so she could work from home, and they gave her an x-ray and this is the diagnosis: "Large aggressive lytic lesion in the left iliac bone involving the acetabular roof; with bone destruction as described. The most likely diagnosis is a lytic osseous metastasis."

My question is, can prolonged stress to the bone cause something that looks like this, but isn't actually cancerous? Her blood work is normal/good. They want her to get a CT scan.

[Multibilly]

Re: Can physical trauma / stress produce lytic lesions?

by Multibilly on Thu Sep 20, 2018 5:41 pm

Hi tetractys,

Welcome to the forum. Sorry to hear about the situa­tion your mom.

Rather than try to come up with an alternative explanation for this situa­tion, I would suggest that your mom first try to eliminate various cancers (including myeloma) as a possibility (lytic osseous metastasis can sometimes look like the lytic bone destruction that can sometimes be associated with myeloma). If she hasn't already done so, your mom should get a serum protein electro­phoresis, serum free light chain assay and serum immunofixation test to see if she may possibly have myeloma or not (these tests are not part of the more standard blood tests such as the comprehensive metabolic or CBC panels). These tests are conducted via simple blood draws and are pretty inexpensive.

A follow-up radiological exam also sounds like a great idea, but I would be pushing for a PET/CT instead of just a CT to see if the bone area in question (and potentially any other areas in her skeleton) has any cancerous activity. The PET portion of PET/CT scan can specifically pick up on and highlight any cancerous cellular activity around the area in the question. Some of the more common causes of lytic osseous metastasis are outlined here:

https://radiopaedia.org/articles/lytic-bone-metastases

[coachhoke]

Re: Can physical trauma / stress produce lytic lesions?

by coachhoke on Fri Sep 21, 2018 9:17 am

Walking (physical trauma) didn't cause the lesion; however, it certainly could have exacerbated the situation.

I agree with Multibilly that the easiest thing to do is the blood draws that he suggests.

I also agree that a PET/CT scan might prove helpful. However, inflammation , not just cancerous cellular activity, may be picked up on the scan.

A biopsy may also be indicated.

Multiple myeloma can sometimes be difficult to diagnose.