title: Spinal metastasis from lung cancer fifteen years after surgery presenting a pseudohemangioma appearance of the vertebra: a case report.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To describe a case of solitary metastasis of the seventh thoracic vertebra (T7) from lung cancer 15 years after surgery.
  
  
  BACKGROUND
  Late recurrence of the bone over 5 years after curative surgery for lung cancer is highly exceptional. In addition, bone metastasis from lung cancer showing a coarse trabecular pattern of the vertebra on computed tomography (CT) is quite unusual.
  
  
  METHODS
  A case of solitary metastasis of T7 from lung cancer 15 years after surgery showing a pseudohemangioma appearance of the vertebra on CT is presented.
  
  
  RESULTS
  A 66-year-old man presented with a 2-month history of gradually progressed numbness and muscle weakness of the bilateral leg, with a more recently developed spastic gate. He had undergone a left lower lobectomy for lung cancer 15 years previously. Magnetic resonance imaging showed an ill-defined mass lesion involving the entire vertebral body of T7 with extension into the posterior element and surrounding soft tissue, which resulted in moderate spinal canal stenosis. CT showed a coarse trabecular pattern at T7 with a mild compression fracture. No other lesion was detected by whole-body CT and bone scintigraphy. Tumor resection and T5-T9 posterior spinal fusion had been performed, and a pathologic diagnosis of metastatic pulmonary adenocarcinoma of the bone was established. Additional radiation therapy (40 Gy) was added, and the patient recovered and continued to survive uneventfully at the 3-month follow-up.
  
  
  CONCLUSIONS
  We have reported a rare case of solitary metastasis to T7 appearing 15 years after surgery for lung cancer. The incidence of lung cancer recurrence more than 5 years after surgery is exceedingly low; however, even in patients with lung cancer, late occurrence of bone metastasis should be considered and included in the differential diagnosis of a pseudohemangioma appearance of the vertebra.
authors.affiliation: Department of Radiology, Asahikawa Medical College, Asahikawa, Japan. tinaoka@asahikawa-med.ac.jp
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inaoka
authors.forename: Koji
authors.initials: K
authors.lastname: Takahashi
authors.forename: Tamio
authors.initials: T
authors.lastname: Aburano
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Miyokawa
authors.forename: Susumu
authors.initials: S
authors.lastname: Tandai
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Takeo
authors.initials: T
authors.lastname: Matsuno
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D006391:Hemangioma / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D011859:Radiography; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*; D013997:Time Factors