Skull surgery

[LoriE]

I've been reading the posts here for 3 years and everyone has been so helpful and knowledgeable. Now I have a question. A CT scan of my head showed a raspberry sized mass inside my mastoid bone. My surgeon removed the mass, which was found to have no malignant cells, but said it was surrounded by "abnormal bone". He drilled away (ew!) all of the abnormal bone that he could without getting too close to nerves and my carotid artery. He said it didn't look like cancer, but "you can't biopsy bone". He said that cancer normally erodes bone, not add bone. He said now we wait. I'm really not good at waiting! Has anyone had anything like this?

[Becky]

Dear Lori

When I was a child I had what was called then, a mastoid which was an ear infection that went to the bone. I am 50 years old and this happened when I was 7. Basically, 43 yrs ago a new antibiotic came out that could potentially "cure" this infection because prior to that, the bone had to be surgically removed. I was in the hospital one week but that antibiotic (I think it was a Tetracycline type if not tetracycline itself) worked. I didn't have to have surgery. However, Xrays showed my bone was disfigured from the incident. I tell my family and friends only so they know so if anything happens to me and a CT of the head is done, they know that disfigurement is just part of who I am forever.

Perhaps it is the same for you in this case. Fight, fight, fight to find out what the raspberry mass is. Is it an old or current infection? Did a bug crawl in your ear (don't laugh, this can happen)

That bone can become infected. It is rarer today with new fangled antibiotics but it does and can - especially for those of us who went through chemo and have depressed immune systems.

We always have to be cautious with these things but it can be something else too.

[ElaineM]

I would get as second opinion about the bone biopsy. A biopsy of a rib can be done, but I don't know about other bones. How about a brain MRI. They show more stuff than cat scans show.
Good luck and keep going !!!!!!!!

[Lani]

of course you can biopsy bone--bone biopsies are done every day.

Bone biopsies apparently take longer to "read out" by pathologists as they have to be decalcified (takes about 3 days) before they can be sliced thinly and inspected under the microscope.

Some tumors/mets affect the inner spongy part of the bone, others the outer hard part of the bone. Some cancers cause an increase in the density of adjacent bone (osteoblastic metastases) some result in a decrease in the density of adjacent bone (osteoclastic metastases). Both slow growing benign and relatively slow growing malignant tumors can "erode bone"

Was the surgeon an ear, nose and throat surgeon or a neurosurgeon?

Orthopaedic surgeons apparently do bone biopsies much more often, although they rarely do skull biopsies (they work from the chin down mostly it seems)

Are you being taken care of at a major cancer center? Are you sure they sent nothing to pathology for examination? Are you sure you understood him correctly and he didn't just mean you had to wait 3 days for the biopsy to be decalcified before it could be examined and read?

[LoriE]

Thanks, Lani. I am taken care of at The James Cancer Hospital at the Ohio State University. The doctor that did the surgery is an OSU ENT specializing in head, neck and cranial base surgery. He said he often operates with "those guys at the James" and has seen cancer in the skull and this didn't look like that. I have an appointment with my regular surgical onc next month. Hopefully, he'll be able to explain this to me.
You know how this goes - everyone says to let it go and not worry, but that's pretty hard to do for us. I, for one, are tired of surprises!

Lori

[Jean]

Lani,
Glad that you mentioned about the bone biopsey.
Back in 2005 there were trials being done with early stage patients that during their lumpectomy a bone biopsey was performed and studied. I have often wondered what if anything ever came of those trials /studies, I have not seen anything about them?

The purpose of the trial/study was to discover how many early stage women had any silent cancer cells
dwelling in the bone.

Thanks,
Jean

[Lani]

Jean those were bone marrow biopsies/aspirates. They usually take an area of bone from the pelvis (which is supposed to be macroscopically normal but may have microscopic dormant tumor cells)

Here we are talking about a mastoid bone biopsies from an area where they See a macroscopic abnormality

Klaus Pantel has written a lot about the prognosis of those who had tumor cells in their bone marrow at the time of their original surgery and after their chemotherapy. They have a worse prognosis, especially if the tumor cells found in their bone marrow were her2+.