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.
N.Z. Increased osteoplastic bone resorption with irregular bone formation leads to focally deficient bone. Paget's disease typically involves the sacrum, spine, femur and cranium of older patients. Some have hypothesised a viral etiology. Radiographic features vary with the stage of the disease but include cortical thickening, coarse trabeculae, sclerotic ivory or enlarged picture frame vertebrae, cotton wool appearance of the femur and pelvis, and osteoporosis circumscripta of the calvarium. Late radiographic hallmarks include enlarged bone, thickened cortices, and prominent trabeculae.