Purpose: To report a case of orbital metastasis from scapular bone osteosarcoma.Case Report: A 55-year-old man who was a known case of scapular bone osteosarcoma, was referred to our clinic with ocular symptoms including acute painful decreased vision, proptosis, conjunctival injection, and chemosis. He had undergone surgical excision of the original tumor and received systemic chemotherapy 4 months before. Imaging studies and incisional biopsy were performed for the orbital lesion, the histopathological examination confirmed the diagnosis of metastatic osteosarcoma. The patient was referred to the oncologist for palliative chemotherapy and further intervention; however, he deceased 2 months later due to sepsis in the context of immunosuppression.Conclusion: Metastatic involvement of the orbit due to osteosarcoma is a rare condition manifesting with orbital mass, pain, diplopia and ocular motility disturbance. Although there is no effective treatment, the combination of modalities such as chemotherapy, radiotherapy, and surgery may delay progression of the disease.

Introduction: Involvement of the skeleton can cause an excruciating pain in two-thirds of terminal patients with a history of malignancy. Due to several limitations of other therapies, such as analgesics, bisphosphonates, chemotherapy, hormonal therapy and external beam radiotherapy; bone-seeking radiopharmaceuticals have an important role in palliation of pain from bone metastases. Although these kinds of therapies have many advantages including the ability to treat multiple sites of tumoral involvement simultaneously, no significant confliction with other treatments, ease of administration and the potential to be used repetitively; in Iran using of this modality is not widely practiced. In this study we evaluated the clinical usefulness of Sm-153 lexidronamfor pain management of bone metastases.Methods: 28 patients (14 males and 14 females) aged 38-77 years with a history of painful bone metastases caused by different cancers, not responding to conventional treatments were included in the study. All patients had a recent whole body bone scan indicating multiple bone metastases.1 mCi/Kg Sm-153 lexidronam was injected intravenously to the patients. Whole body scintigraphy was done 3 or 18 hours post injection. Pain relief and quality of life have been evaluated by analog pain scale and Karnofsky index every week, respectively. Also, all patients were evaluated for hematological toxicity every two weeks. Active follow ups were performed.Results: 43% of patients showed the presence of the flare phenomenon during the first three days after Sm injection with a mean duration of 2.2 days. The pain relief began between 2 and 16 days post injection and the duration of pain palliation was in the range of 4 to 32 weeks (mean±SD=15.22±7.8).64.3% of patients showed complete relief of pain and 21.4% achieved partial response to therapy. (Over all response to therapy was 85.7%). The lowest amount of peripheral blood cells was detected in the fourth week for RBCs and in the 6th week for WBCs and PLTs. No one experienced hematological toxicity induced problems.Conclusion: Sm-153 lexidronam is an effective treatment for painful bone metastases. The complication rate is low and the quality of life of the patients after treatment would be significantly improved.

Hepatocellular carcinoma is the most common type of primary liver cancer. It metastasizes via blood or through lymphatic dissemination, most comonly to the lungs, abdominal lymph nodes, and bones. Metastases to the bones of the head and neck region, however, are extremely uncommon. A 70-year-old male was presented with a mass in the left zygomatic region. After the incisional biopsy, the histopathologic and immunohistochemical analysis confirmed a metastasis of hepatocellular carcinoma. An abdominal computerized tomography (CT) scan revealed a large primary tumor in the right liver lobe. To the best of our knowledge, this is the second case of an isolated zygomatic metastasis as an initial presentation of hepatocellular carcinoma. We also reviewed the literature regarding clinical and histopathologic characteristics of hepatocellular carcinoma that produced metastases to the zygomatic bone and the maxilla.

Introduction: Despite prominent progress in the treatment and prevention of cancer in the last decades, breast cancer still ranks among the most prevalent and deadly cancers in women. Thus, research on potential causes, risk factors, symptoms and treatments is in abundance. One of the most common and painful consequences of breast cancer is bone metastasis. bone scan is currently used for detecting the asymptomatic bone metastasis; however, researches are continuing for simpler and accurate new methods for detection of early bone metastasis. CA 15-3 is a newly proposed tumor marker which has been shown to be efficient in detection of remote metastasis in breast cancer. This study aimed at comparing the bone scan and CA 15-3 titer in patients with breast cancer for evaluation of bone metastasis.Methods: In an analytic-descriptive setting, 35 patients with definite diagnosis of breast cancer were evaluated in Tabriz Imam Khomeini Hospital during one-year period. bone scan with99mTc-MDP, considered as reference method, was carried out in all patients. The serum level of CA 15-3 was measured by ECLIA method. The increased level was considered as>30 U.ml. The serum level of CA 15-3 was compared between the patients with and without bone metastasis, as well as its correlation with the extent of bone involvement.Results: Thirty five patients with the mean age of 51.69±10.77 (34-81) years were enrolled in the study.According to bone scan results, 24 (68.8%) patients revealed bone metastasis. The mean level of serum CA 15-3 was significantly higher in pat with bone metastasis in comparison with patients without metastasis (26.37±4.74 U/ml vs.19.09±1.99 U/ml; p<0.001); however, the rate of increase CA15-3 antigen was comparable between the two groups (12.5% of the patients with bone metastasis vs.0 in other group; p=0.536). There was no considerable and significant correlation between the serum level of CA15-3 and the extent of bone metastasis (rho=-0.063, p=0.769). Coordinates of the curve study yielded a cut-off point>21.8 U/ml for the serum level of CA 15-3 in our patients, with a sensitivity and specificity of 91.7%, respectively.Conclusion: This study showed that the serum level of CA15-3 antigen is higher in the patients with bonemetastatic breast cancer; however, the recommended cut-off point might not be suitable for Iranian patients.Further studies with large sample sizes are recommended.

bone is the second most frequent target of distant metastases in patients with differentiated thyroid cancer (DTC). Prognosis and outcome of these patients is unfavorable.We retrospectively reviewed Medical records of Patients with DTC having bone, who registered in our hospital between 2000 and 2005. We found 57 patients having bone metastasis.All 57 patients had bone metastasis at the time of presentation in hospital, and none developed it during the course of their treatment. It was found that 52% patients presented to the hospital due to some complication of their bone metastasis, while 48% patients were found to have bone metastasis during baseline investigations. Patients who presented to the hospital with complication of bone metastasis when enquired about their neck disease‐ 59% had long standing MNG and they did not want any treatment because it was not causing any problems. Patients who didn’t know about their neck disease were 22%, while 19% patients had previous thyroidectomy, and were not properly guided or had misplaced histopathology report.Although majority of patients of DTC present late with bone metastasis due to patient related factors but a large percentage are being missed due to hospital related factors. We suggest Patient education as well as strict hospital policy for post‐perative patient guidance to reduce patient presentation at this late stage.