Skeletal metastases

Skeletal metastases

Nearly all malignant tumours can metastasize to bone, but 80% are from prostate, breast, lung or kidney. Mainly involves the axial and proximal appendicular skeleton (red marrow)—distal appendicular bone metastases are rare and usually from lung or, less commonly, breast. Most bone metastases are lytic; sclerotic or mixed metastases have a more limited differential, though treated lytic metastases can become sclerotic. The lists below cover the more common sources.

Lytic

  • 1. Lung .
  • 2. Breast —usually lytic but can be sclerotic or mixed.
  • 3. Myeloma .
  • 4. Nonmucinous adenocarcinomas of the GI tract .
  • 5. Most other primary sources .

Lytic and expansile

  • 1. Renal cell carcinoma .
  • 2. Thyroid .
  • 3. Hepatocellular carcinoma.
  • 4. Melanoma.
  • 5. Phaeochromocytoma.

Sclerotic

  • 1. Prostate .
  • 2. Breast — particularly post treatment.
  • 3. Carcinoid.
  • 4. Mucinous adenocarcinomas of the GI tract.
  • 5. Transitional cell carcinoma.
  • 6. Small cell lung cancer.
  • 7. Lymphoma —particularly Hodgkin lymphoma; rare.

Mixed

  • 1. Breast .
  • 2. Lung .
  • 3. Lymphoma .
  • 4. Cervix.
  • 5. Testis.
  • 6. Transitional cell carcinoma.
  • 7. Melanoma.
  • 8. Neuroblastoma —in children.
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