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Topic: Bone lesion on X-ray but not MRI (??)

Forum: Not Diagnosed With a Recurrence or Metastases but Concerned —

Meet others concerned about developing a recurrence or metastases.

Posted on: Sep 10, 2018 04:34PM - edited Sep 10, 2018 05:03PM by steiner18

steiner18 wrote:

Been having shoulder pain for several months now, the top of the shoulder (greater tuberosity of the humerus...technical term the ortho doc used), left/cancer side, 6 years out. Xray showed a lesion on the bone, but a MRI w/o contrast came back completely clean of anything. He gave me a cortisone injection to help with pain and said since I've had a negative bone scan a few months ago, and this negative shoulder MRI that he's not concerned it's anything cancer-related. But of course I'm not comfortable with that for an answer and would like something a bit more concrete as to what is causing the pain. I realize there's not much more to do after MRI though.... There's a lesion on an X-ray in the exact place I'm having dull, achy pain that is to the point that it is waking me up at night. I'm baffled how it would appear on Xray but not MRI, but I'm no radiologist. Has anyone here heard of or experienced something similar?

Edited to add: should also mention I've not had any shoulder injury nor any repetitive use of my arm/shoulder that would be causing this pain. Just came out of the blue.

Dx 10/18/12, IDC 1.5cm Stage I Grade 3 Triple+ 0/4 nodes *BMX w/TE 11/5/12 *Chemo/Herceptin (TCH) 12/4/12 *Tamoxifen 4/1/13 *Reconstruction (implants) 5/6/13 *Hysterectomy/ Oopherectomy 10/25/13 *Femara 2/1/15 *Craniotomy benign brain tumor 10/5/16
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Sep 10, 2018 09:28PM KBeee wrote:

my “similar” situation is opposite. I had a lesion on MRI, but not on X-ray... also months of pain in same spot as yours. I think (bug am not 109% sure) that mine was with contrast. Ask the radiologist if that would show it more clearly. Mine was an ostiochondral lesion, not cancer.

Can they repeat the X-ray in a few months to see if it changes? (Though I know waiting rots

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 8/25/2013 Mastectomy: Left, Right Chemotherapy 9/19/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/11/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/22/2014 Reconstruction (left); Reconstruction (right) Surgery 1/28/2015 Lumpectomy: Right Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- (FISH) Surgery 2/24/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary; Prophylactic ovary removal Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- (IHC) Chemotherapy 3/30/2015 AC + T (Taxol) Radiation Therapy 8/24/2015 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)
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Sep 11, 2018 12:19AM steiner18 wrote:

Thank, Kbeee for the feedback. This was an orthopedic surgeon who ordered the MRI w/o contrast. I think he was looking for rotator cuff, or some other shoulder issue. My oncologist sent me to him when the bone scan came back clear. He didn't order with contrast because he wasn't looking for tumor(s), even though he knew my history. I asked if a tumor would have shown up without the contrast just as well and he said yes. But then I wonder why MRI contrast is even used at all to evaluate bone tumors if that's the case?

I'm just at a loss now. Still a very steady and significant amount of pain, doesn't really go away or let up...fairly constant dull ache. Worse at night when I'm sleeping to the point of waking me at times. More advanced scans not showing anything, but basic xray shows a lesion. Weird! But doc doesn't think much of it in terms of being a tumor since other scans were negative. Of course, I just want a concrete answer of what it is/isn't because of my history and because I'm hurting and that lesion is the spot where it hurts! It's on my cancer side, on the humerus, and I'm not sure what to do next (if anything). Surely insurance isn't going to cover any further (different) scans. I wondered about a 2nd opinion with an orthopedic oncologist, taking him/her copies of my scans to see what they thought. The last time my oncologist brushed me off about chronic headaches I went on my own volition to see a neurologist because I was desperate and we learned I had a benign brain tumor. I'm just trying to find that balance of listening to my gut vs not being overly neurotic!

Did you have any treatment for your osteochondral lesion? Was it from an injury or just random? I had a cortisone injection today...ouch! Not sure how much it will end up helping, but I guess I appreciate the attempt at trying to alleviate the pain. I see him again in 4 weeks and he said we will repeat xray in 6 weeks and can repeat MRI in 3 months. I think I may ask for MRI with contrast next time around. I know there are risks from the dye related to the kidneys, I'll have to weight the risk vs benefit.

Dx 10/18/12, IDC 1.5cm Stage I Grade 3 Triple+ 0/4 nodes *BMX w/TE 11/5/12 *Chemo/Herceptin (TCH) 12/4/12 *Tamoxifen 4/1/13 *Reconstruction (implants) 5/6/13 *Hysterectomy/ Oopherectomy 10/25/13 *Femara 2/1/15 *Craniotomy benign brain tumor 10/5/16
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Sep 11, 2018 05:00PM KBeee wrote:

I have not had treatment for my osteochondral lesion. He says it is not cancer, and is most likely from an old injury. The only old injury I had was in 1991! Weird that it would start hurting now. The pain is worsening, even with a cortisone injection, so I may eventually have him address it surgically since there is also a bone spur in there (that may be the source of the pain) and it keeps me up at night. We are really shorthanded at work right now, so I'm waiting until we get a few more people hired and then may address it. I do hesitate a little because I had a LOT of radiation damage, and am afraid it might not heal. Sigh....if only we could look ahead and predict outcomes! Hoping you get concrete answers. It is frustrating.

Asking for a second opinion to look at your scans would be a good idea.

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 8/25/2013 Mastectomy: Left, Right Chemotherapy 9/19/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/11/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/22/2014 Reconstruction (left); Reconstruction (right) Surgery 1/28/2015 Lumpectomy: Right Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- (FISH) Surgery 2/24/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary; Prophylactic ovary removal Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- (IHC) Chemotherapy 3/30/2015 AC + T (Taxol) Radiation Therapy 8/24/2015 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)
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Sep 11, 2018 06:43PM lekker wrote:

Maybe try going back to your oncologist to follow up the x Ray. I think the usual progression of tests for suspected bone mets is x Ray, bone scan, then either CT or MRI - with and without contrast. The onc would order it I think. I had bad back and shoulder pain a while ago and had x rays first, then bone scan, then MRI with and without contrast. I had a bone spur in my shoulder and bulging disks in my back.Good luck and I hope it’s nothing.

Colorectal carcinoma in situ January 2000 (age 30), and now this... Dx 7/2012, ILC, Right, 1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 8/5/2012 Lumpectomy: Right Surgery 10/2/2012 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 3/11/2013 Reconstruction (left); Reconstruction (right) Surgery 4/10/2013 Prophylactic ovary removal
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Sep 11, 2018 10:23PM JoE777 wrote:

I had two sets of extensive X-rays while in terrible pain and they showed absolutely nothing. An MRI without contrast showed 5 tumors in my sacrum along the spine. Distant metastasis. Pet scan confirmed the MRI

Dx 2/2012, IDC, Left, 2cm, Stage IIA, metastasized to bone, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 4/3/2012 Lumpectomy: Left; Lymph node removal: Sentinel Dx 2/2018, IDC, Stage IV, metastasized to bone/lungs, Grade 1, ER+/PR+, HER2- Targeted Therapy Kisqali Hormonal Therapy Femara (letrozole) Chemotherapy Other Radiation Therapy External: Bone Hormonal Therapy Aromasin (exemestane), Femara (letrozole) Radiation Therapy Whole-breast: Breast, Lymph nodes
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Sep 13, 2018 09:11AM steiner18 wrote:

lekker, thank you for the feedback. I may do that after I follow up with the orthopedic doc in October. Where’s your bulging disc at? I’ve got one of those too in my lumbar spine and it can be a bear. I’m the oldest 37 year old I know! Lo

JoE777, I am sorry for your diagnosis. Thank you for sharing. What you described makes sense to me, that something wouldn’t show on X-ray but it did on MRI and then Pet, and that’s been typically what I’ve heard of...someone has pain that doesn’t show on scans, pain persists so different scans (more sensitive and specific) are ordered and then it shows up. My instance is opposite where something shows on the X-ray but the MRI report makes no mention of it. It’s confusing to me because it seems backwards.

Dx 10/18/12, IDC 1.5cm Stage I Grade 3 Triple+ 0/4 nodes *BMX w/TE 11/5/12 *Chemo/Herceptin (TCH) 12/4/12 *Tamoxifen 4/1/13 *Reconstruction (implants) 5/6/13 *Hysterectomy/ Oopherectomy 10/25/13 *Femara 2/1/15 *Craniotomy benign brain tumor 10/5/16
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Sep 13, 2018 11:25AM JoE777 wrote:

That's why I call breast cancer the nasty, sneaky thing.

Dx 2/2012, IDC, Left, 2cm, Stage IIA, metastasized to bone, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 4/3/2012 Lumpectomy: Left; Lymph node removal: Sentinel Dx 2/2018, IDC, Stage IV, metastasized to bone/lungs, Grade 1, ER+/PR+, HER2- Targeted Therapy Kisqali Hormonal Therapy Femara (letrozole) Chemotherapy Other Radiation Therapy External: Bone Hormonal Therapy Aromasin (exemestane), Femara (letrozole) Radiation Therapy Whole-breast: Breast, Lymph nodes

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