[Osteonecrosis, metastases and bronchial carcinoid]

The authors report the case of a 35-year-old woman undergoing surgery in 1976 for a bronchial carcinoid tumour, considered to be benign. Twelve years later, diagnostic evaluation of liver metastases led to the discovery of an asymptomatic lesion of D10, the CT scan and NMR appearances of which were suggestive of osteonecrosis, a diagnosis confirmed histologically. Investigations were repeated 2 years later because of spinal pain. While NMR and CT scan remained compatible with bone necrosis, biopsy on this occasion confirmed the presence of carcinoid tumour. These rare tumours metastasise little. Secondary bone deposits, essentially axial, are of an osteoblastic nature. The lesion seen in our patient was closer to idiopathic bone infarcts or those associated with Gaucher's or sickle cell diseases than to classical vertebral osteonecrosis. The relationship between vertebral necrosis and metastasis remains obscure.