Senior Lecturer, Dept. of Orthopaedic Surgery, University of Sydney, Australia. The most common bony malignancies are metastatic carcinomas. With improved treatment regimens, which has prolonged survival, the deletion is involved in over half of all metastatic carcinomas through hematogenous spread. Metastatic lesions represent the most common cause of pathology fractures due to a neoplasm. Usually are multiple, but can be solitary.
Most common primaries are breast, prostate, lung, kidney and thyroid, in that order.
Renal mets are quite vascular and have cold bone scans, and histology may demonstrate clear cells that are PAS positive. Prostate and breast mets are typically osteoplastic. Shorter survival periods can be anticipated with lung cancer, and longer periods with thyroid mets. Bone scans, tomograms, and CT are often helpful, spontaneous resolution. Treatment ordinarily consists of surgical removal of the nidus with a marginal excision.