Case of the Month       October, 1999

Case summaries taken from the monthly Orthopedic Oncology - Radiology - Pathology Multidisciplinary Conference at the University of Massachusetts Medical School

Case presentation:

A sixty-four year old woman had documented multiple myeloma. She had severe pain in the right groin that interfered with walking and bothered her when she sat in a chair. Multiple other lesions were present in the pelvis, spine, ribs, and the long bones. None of these was large enough at the time to present a risk of pathological fracture. The patient has had several courses of radiation therapy to lesions in the pelvis and elsewhere.

On examination, the right side of the symphysis pubis is very painful to palpation. A plain radiograph of the pelvis and a close up of the symphysis pubis is shown. Click the images to view. What are the treatment options?

There is a lesion on the ight side of the symphysis pubis wich is responsible for the severe focal pain. Treatment options were limited by the fact that radiation has already been given and the dosage limits may be reached. Surgical resection was not practical in this patient, and even limited open stabilization of the pelvic metastasis would require a significant operative morbidity, cost, and a prolonged recovery. Palliative care with rest and narcotics was possible, but the patient lived alone and did not wish to become bed-ridden or house bound.

Treatment chosen was percutaneous stabilization of the pelvic lesion by injection of methylmethacrylate (PSM). This was accomlished under general anaesthesia due to the locaion of the lesion (click to see intra-operative photo) PMMA is used to fill the lesion to stabilize the bone and treat the pain.

After stabilization, (click for view of methylmethacrylate in the lesion) the patient had damatic reduction in her groin pain and resumed ambulation and normal acivities. This innovative technique is being applied to carefully selected patients at the author's institution.

At the time of follow-up, the patient had sustained pain relief.

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