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PubMed1998

[Adjuvant chemotherapy for colon adenocarcinoma in the county of Côte-d'Or].

OBJECTIVES: The aim of this study was to assess the use of adjuvant chemotherapy in colon adenocarcinomas on a population basis and determine which factors could modulate its prescription. METHODS: The influence of time of diagnosis, age, sex, place of residence, health care pattern, tumor location and number of metastatic lymph nodes was investigated from the 1988 to 1995 data from the Registry of Digestive Cancers in Côte-d'Or (France). Each independent variable was given an odds-ratio (OR). RESULTS: An adjuvant chemotherapy was performed for 0.9% of 231 Dukes'A cancers, 3.8% of 367 Dukes'B and 16.7% of 264 Dukes'C. For the latter, the prescription of adjuvant chemotherapy was influenced by time of diagnosis (from 1.3% in 1988-89 to 35.8% in 1994-95; OR = 228 for period 1994-95 compared with the first period), age (the proportion of treated patients under 75 years of age has increased from 2.2% in 1988-89 to 57.9% in 1994-95; OR = 30.1 for patients younger than 75 years compared with older ones) and health care pattern (OR = 0.21 for treatment in non university hospitals and 0.06 in the private sector compared with university hospitals. CONCLUSION: In spite of an increasing proportion of patients treated by adjuvant chemotherapy for Dukes'C colon cancers, this treatment of proved effectiveness has not yet reached its full development.

Adenocarcinoma↗

PubMed1993

Three subtypes of gastric argyrophil carcinoid and the gastric neuroendocrine carcinoma: a clinicopathologic study.

BACKGROUND: Enterochromaffinlike (ECL) cell carcinoids recently observed in rats stimulated new interest in gastric endocrine tumors arising in humans. METHODS: Paraffin-embedded sections of 55 endocrine tumor cases were stained with H&E, mucin tests were performed, and immunoperoxidase was used for detecting endocrine markers; 23 cases were also investigated ultrastructurally. RESULTS: Forty-five argyrophil carcinoids, 9 neuroendocrine carcinomas, and 1 gastrinoma were identified. Three clinicopathologic subtypes of carcinoids were characterized: (1) twenty-eight cases, none metastatic, arose in a background of body-fundus atrophic gastritis and hypergastrinemia; (2) seven cases, 2 locally metastatic, were associated with hypertrophic gastropathy and hypergastrinemia due to multiple endocrine neoplasia/Zollinger-Ellison syndrome; and (3) ten were sporadic cases, 7 of which were deeply invasive, 6 metastatic, and 5 histologically atypical. All carcinoids showed histochemical and ultrastructural patterns of ECL cells. The 9 neuroendocrine carcinomas, all deeply invasive and metastatic, were composed of anaplastic, small- to intermediate-sized cells with high mitotic index and focal necrosis. CONCLUSIONS: Gastrin-promoted carcinoids represent a benign or low grade tumor disease, whereas sporadic carcinoids and neuroendocrine carcinomas are life-threatening neoplasms, independent of gastrin promotion.

Adult↗

PubMed1999

Splenosis mimicking metastases from breast carcinoma.

The case history is presented of a patient with breast cancer who was extensively investigated for presumed hepatic metastases, which were finally diagnosed as splenosis, the heterotopic autotransplantation of splenic tissue after traumatic rupture of the spleen. This case history highlights the importance of obtaining a pathological diagnosis prior to labelling a patient as having metastatic disease. This is especially important for patients who have an unusual pattern or appearance of metastases or for whom the risk of metastatic disease is presumed to be minimal.

Breast Neoplasms↗

PubMed1995

Central nervous system progression of metastatic breast cancer in patients treated with paclitaxel.

BACKGROUND: The possibility of tumor sanctuary sites in the central nervous system (CNS) of patients receiving paclitaxel has been suggested by laboratory data identifying low concentrations of drug in the brain and cerebrospinal fluid (CSF) of rats. METHODS: The pattern of disease progression in patients with metastatic breast cancer who had an initial response to paclitaxel treatment in five Phase II trials at the Memorial Sloan-Kettering Cancer Center was reviewed. RESULTS: Of 152 patients, 53 had a partial or complete response, and 25 had a minor response. Of the 78 patients who responded to paclitaxel, 52 had subsequent disease progression, 22 changed treatments before progression occurred (as specified by the protocol and/or to receive high dose consolidation chemotherapy), 2 stopped receiving treatment because of toxicity, 1 continued receiving treatment, and 1 died with no evidence of disease progression. Six of the 52 patients who progressed after initially responding to paclitaxel had isolated CNS progression while maintaining their systemic response (leptomeningeal metastasis in three, brain metastases in two, brain and leptomeningeal metastases in one). One patient had CNS progression (brain metastases) associated with other systemic sites of progression. All patients with CNS disease developed neurologic symptoms, prompting neurologic evaluation; one had only a mild headache, which was not recognized until evaluation for paclitaxel-related peripheral neuropathy. CONCLUSIONS: These data suggest that the CNS, and particularly the CSF, is an important sanctuary site for patients with metastatic breast cancer receiving paclitaxel.

Blood-Brain Barrier↗

PubMed1995

Cloning and identification of genes differentially expressed in metastatic and non-metastatic rat rhabdomyosarcoma cell lines.

The objective of this study was to identify genes involved in invasion and metastasis using a rat rhabdomyosarcoma model (SMF-A and RMS-B cell lines). The SMF-A cell line was established from a metastatic nodule of an induced rhabdomyosarcoma in syngeneic F344 rats. Two cell lines with defined metastatic potentials, SMF-Ai and SMF-Da, were cloned from the SMF-A line. The cell line SMF-Ai is tumorigenic, highly invasive and highly metastatic. On the other hand, the revertant line SMF-Da is less tumorigenic, non-invasive and non-metastatic. We have isolated from a SMF-Ai cDNA library eight cDNA clones which are differentially expressed by the metastatic SMF-Ai and the non-metastatic SMF-Da cell line using Northern blot analysis. Five of these clones, smf-4, smf-6, smf-41, smf-42 and smf-44, are overexpressed in the SMF-Da cell line and have homology with beta-2-microglobulin, lactate dehydrogenase, ribosomal protein L38, ribosomal protein S4 and acidic ribosomal phosphoprotein P1, respectively. The three other clones, smf-7, smf-40 and smf-61, are overexpressed in SMF-Ai. Clones smf-40 and smf-61 show significant homology with the human TB3-1 gene and the human fus gene respectively. The clone smf-7 has no significant homology with known sequences. We also analyzed the expression of these clones in other rat rhabdomyosarcoma cell lines (RMS-B and their clones) and in tumors obtained by injection of these cell lines into rats or nude mice. Smf-61 and smf-7 were the only clones with a differential expression pattern associated with the invasive or metastatic potential of all cell lines examined. A preliminary study of the expression of smf-7 and smf-61 in other cancer cell lines also showed mRNA expression in two human rhabdomyosarcomas and a human epidermoid carcinoma suggesting the existence of genes homologous to smf-7 and smf-61 clones in human cancers. Our findings suggest an association between the expression of smf-7 and smf-61 and invasive or metastatic potential of rhabdomyosarcoma cells.

Animals↗

PubMed2006

[The importance of immunohistochemistry for the diagnosis of cholangiocarcinomas].

The correct diagnosis of intrahepatic cholangiocarcinoma (CC) is often confounded by the small size of the diagnostic specimen and the wide morphological range of carcinomas metastasising to the liver. Expression analysis of cytokeratins, glycoproteins, mucoproteins, adhesion molecules, receptors and transcription factors has been shown to be a valuable adjunct in the typing of carcinomas. For this study, the expression pattern of 30 well documented antibodies to CC and the most common metastatic adenocarcinomas of the liver were studied. CC show a rather distinct immunophenotype with co-expression of CK7, CK17, CD7 and a lack of CDX2. Although this pattern allows the separation of CC from most metastatic carcinomas, pancreatic carcinomas show a broad overlap with this expression pattern.

Bile Duct Neoplasms↗

PubMedDate not supplied

Single shot fast spin echo diffusion-weighted MR imaging of the spine; Is it useful in differentiating malignant metastatic tumor infiltration from benign fracture edema?

PURPOSE: This study aims to evaluate the usefulness of single shot fast spin echo diffusion-weighted MR imaging (DWSSFSE) in differentiating malignant metastatic tumor infiltration of vertebral bone marrow from benign vertebral fracture edema. MATERIALS AND METHODS: Forty-six consecutive patients with 59 acute osteoporotic or traumatic vertebral fractures (mean age = 59) and 31 patients with 98 vertebral metastasis including 20 pathologic fractures (mean age = 53) were included in this study. Diffusion-weighted MR images were obtained by single-shot fast spin echo technique with diffusion gradient (b = 500 s/mm2, TR/TE: 5002/99) by using a 1.5 T MR scanner (Signa MR/i; GE Medical Systems, Milwaukee, WI, USA). T1- and T2-weighted images and short inversion time inversion-recovery (STIR) images were available in all 157 lesions, while contrast-enhanced images were available in 98 metastatic lesions. We evaluated signal intensity patterns on DWSSFSE in 157 lesions, which showed low signal intensity on T1-weighted images in both benign fractures and metastasis. The lesions on DWSSFSE were categorized as low, intermediate, and high signal intensity relative to presumed normal vertebra by concordant inspection of two experienced musculoskeletal radiologists. RESULTS: In benign fractures, DWSSFSE images showed low signal intensity in 56 vertebrae (95%) in 43 patients (93%) and intermediate signal intensity in only 3 vertebrae (5%) in 3 patients (7%). On the other hand, metastases most commonly had low signal intensity in 57 vertebrae (58%) in 25 patients (80%), intermediate signal intensity in 35 vertebrae (36%) in 16 patients (52%), and high signal intensity in 6 vertebrae (6%) in 3 patients (10%). Thus, intermediate and high signal intensities are far more common than benign fractures. Such differences in signal intensity were statistically significant (chi-square test, P < .05). High or intermediate signal intensity on DWSSFSE was highly specific for the diagnosis of metastatic tumor infiltration of the spine (sensitivity: 42%; specificity: 95%; true positive rate: 93%; false negative rate: 52%). CONCLUSIONS: DWSSFSE of the spine may be useful in differentiating metastatic tumor infiltration of vertebral bone marrow from benign fracture edema.

Diagnosis, Differential↗

PubMed1999

Allelic imbalance in the clonal evolution of prostate carcinoma.

BACKGROUND: To understand better the genetic basis of the clonal evolution of prostate carcinoma, the authors analyzed the pattern of allelic loss in 25 matched primary and metastatic prostate tumors. METHODS: Twenty-five cases were selected from the surgical pathology files of the Mayo Clinic from patients who had undergone radical retropubic prostatectomy and bilateral lymphadenectomy between 1987-1991. All patients had regional lymph node metastases at the time of surgery. DNA samples for the analysis of allelic loss pattern were prepared from primary tumors and matched synchronous lymph node metastases by tissue microdissection. The oligonucleotide primer pairs for the microsatellite DNA markers were D8S133, D8S136, D8S137, ANK1 on chromosome 8p12-21, LPLTET on chromosome 8p22, and D17S855 (intragenic to the BRCA1 gene) on chromosome 17q21. One case was not informative at any of the loci tested and was excluded from further analysis. RESULTS: The overall frequency of allelic imbalance was 79% in primary tumors and 88% in paired metastases. Of 24 informative cases, 14 patients (58%) showed the same pattern of allelic loss or retention in matched primary and metastatic tumors at all marker locus; discordant allelic loss was observed in the remaining 10 patients (42%). Four patients showed loss of the same allele at one or more marker loci in both primary and metastatic tumors, but discordant allelic loss was observed at other marker loci. Five patients showed allelic loss in at least one genetic marker in the metastatic tumor but not in its matched primary tumor. Five patients displayed loss of one allele at one or more marker loci in a primary tumor but not in the matched metastases. There was no significant difference in the frequency of allelic imbalance between primary and metastatic tumors at any marker analyzed (P>0.05). CONCLUSIONS: These data suggest that different patterns of allelic deletion may be acquired during cancer progression to metastases. The differences in genetic composition between primary prostate carcinoma and its metastases may be related to intrinsic cancer heterogeneity, overall genetic instability, and clonal divergence.

Aged↗

PubMed1996

Patterns of failure following treatment of pseudomyxoma peritonei of appendiceal origin.

Pseudomyxoma peritonei is a rare disease caused by a perforated adenoma of the appendix. It results in extensive accumulation of mucinous tumour at specific locations within the abdomen and pelvis. The study was undertaken to examine patterns of recurrence in patients with grade I disease treated by cytoreductive surgery and early postoperative intraperitoneal chemotherapy. After a median follow-up of 1.9 years (range 0.5-7.4 years) 42 out of 118 patients had recurred. In 32 patients, detailed information regarding the anatomical location of recurrent tumour from CT-scan and second-look laparotomy were available and these form the basis of this study. The volume of recurrent tumour was recorded at eight abdominal sites, the laparotomy scar and at suture lines. Patient, tumour and treatment factors were analysed for possible relationship with the pattern of recurrence. With recurrence, true metastatic disease was observed in 3 patients and a distinctly higher grade of intraperitoneal tumour in another patient. Pleural spread of pseudomyxoma was found in 6 patients, always related to entering the pleural cavity during cytoreduction (P = 0.000031). Two abdominal sites consistently had an increase in tumour deposits at re-operation as compared to the initial cytoreduction. Small bowel had large deposits at re-operation in 17% versus 3% at initial cytoreduction and retroperitoneal surfaces 10% versus 0%. Recurrences were most frequent in the left subhepatic/lesser omentum area (28%), while the right subdiaphragmatic area (3%) was least involved. Pseudomyxoma peritonei recurrence in the laparotomy scar was found in 15/29 patients (52%), significantly more frequent if tumour had been present at former laparotomy scars during cytoreduction (P = 0.042). In 15/25 (60%) of patients, recurrences were found at suture lines. Differences in the completeness of cytoreduction, inadequate distribution of intraperitoneal chemotherapy to upper abdominal and small bowel surfaces, and entrapment of tumour within suture lines were thought to be causal factors consistent with this pattern of recurrence. Consequences for future treatment strategies are discussed.

Abdomen↗

PubMed1997

[Pulmonary metastasis after resection of non-invasive thymoma: a case report--analysis of nuclear DNA pattern and pathological findings].

After resection of a non-invasive thymoma, two metastatic lung tumors were found in the left upper lobe and the left lower lobe. There were differences in tumor doubling time (TDT) and invasion between the metastatic tumor in the lower lobe and the one in the upper lobe. The TDTs of the tumors were 834.1 days and 328.3 days, and the tumor of the left lower lobe invaded the left lateral basal segmental bronchus (B9). The differences in the two tumors were determined by pathological findings and nuclear DNA pattern. Pathologically, the resected thymoma and both of the metastatic tumors were mixed type, which consisted of epithelial cells and lymphocytes. But by epithelium form, the resected thymoma and the tumor in the lower lobe were classified as cortex type, and only the slow growing tumor in the upper lobe contained a spindle-cell component. The DNA pattern of the resected thymoma was aneuploid and the two metastatic tumors were diploid. As this case is very interesting clinically and pathologically, we reported it.

Cell Division↗

PubMed1988

The diagnostic utility of the keratin profiles of hepatocellular carcinoma and cholangiocarcinoma.

A total of 32 hepatocellular carcinomas (HCC), 10 cholangiocarcinomas (CC), one combined HCC-CC, and 10 adenocarcinomas metastatic to the liver were studied immunohistochemically using AE1 and Cam 5.2, monoclonal antikeratin antibodies with different specificities. AE1 recognizes keratins with molecular weights of 56.5, 50/50', 48, and 40 kd (keratin nos. 10, 14, 15, 16, and 19, according to Moll's catalog), and labels many epithelia, including bile duct epithelium, but not hepatocytes. Both biliary epithelium and hepatocytes are stained by Cam 5.2, which reacts with keratins of molecular weights 50, 43, and 39 kd (corresponding to keratin nos. 8, 18, and 19). Tissues were formalin fixed, paraffin embedded, and a three-stage immunoperoxidase technique was employed. Of 32 pure HCCs, 29 were unreactive with AE1 yet were positive with Cam 5.2. The intensity and extent of immunostaining with Cam 5.2 did not correlate with tumor grade. In contrast to the HCCs, all 10 CCs and the 10 hepatic metastases were strongly positive with both AE1 and Cam 5.2. The combined HCC-CC was also labeled by both antibodies. We conclude that most HCCs express an immunohistochemical keratin profile identical to that of nonneoplastic hepatocytes, which differs from the keratin patterns of bile ducts, CCs, and metastatic adenocarcinomas from a variety of primary sites. These differences in immunoreactivity with antikeratin antibodies may prove useful in diagnostic surgical pathology.

Adenoma, Bile Duct↗

PubMed2004

Identification and testing of a gene expression signature of invasive carcinoma cells within primary mammary tumors.

We subjected cells collected using an in vivo invasion assay to cDNA microarray analysis to identify the gene expression profile of invasive carcinoma cells in primary mammary tumors. Expression of genes involved in cell division, survival, and cell motility were most dramatically changed in invasive cells indicating a population that is neither dividing nor apoptotic but intensely motile. In particular, the genes coding for the minimum motility machine that regulates beta-actin polymerization at the leading edge and, therefore, the motility and chemotaxis of carcinoma cells, were dramatically up-regulated. However, ZBP1, which restricts the localization of beta-actin, the substrate for the minimum motility machine, was down-regulated. This pattern of expression implicated ZBP1 as a suppressor of invasion. Reexpression of ZBP1 in metastatic cells with otherwise low levels of ZBP1 reestablished normal patterns of beta-actin mRNA targeting and suppressed chemotaxis and invasion in primary tumors. ZBP1 reexpression also inhibited metastasis from tumors. These experiments support the involvement in metastasis of the pathways identified in invasive cells, which are regulated by ZBP1.

Actins↗

PubMed2004

Polyomavirus middle T-induced mammary intraepithelial neoplasia outgrowths: single origin, divergent evolution, and multiple outcomes.

The development of models to investigate the pathobiology of premalignant breast lesions is a critical prerequisite for development of breast cancer prevention and early intervention strategies. Using tissue transplantation techniques, we modified the widely used polyomavirus middle T (PyV-mT) transgenic mouse model of breast cancer to study the premalignant stages of tumorigenesis. Premalignant atypical lesions were isolated from PyV-mT transgenic mice and used to generate two sets of three mammary intraepithelial neoplasia (MIN) outgrowth lines. Investigation of these six unique lines, each of which fulfills the criteria for MIN, has provided new information regarding the biology of PyV-mT-induced neoplasia. Although expression of the PyV-mT transgene was the primary initiating event for all lines, they exhibited different tumor latencies, metastatic potentials, and morphologies. Six distinguishable morphologic patterns of differentiation were identified within the premalignant outgrowths that are likely to represent several tumorigenic pathways. Further, several tumor phenotypes developed from each line and the tumors developing from the six lines had different metastatic potentials. These observations are consistent with the hypothesis that distinct pathways of PyV-mT-initiated neoplastic progression lead to different outcomes with respect to latency and metastasis. The MIN outgrowth lines share several characteristics with precursors of human breast cancer including the observation that gene expression profiles of tumors are more similar to those of the MIN outgrowth line outgrowth from which they developed than to other tumors. These lines provide an opportunity to study the full range of events occurring secondary to PyV-mT expression in the mammary gland.

Animals↗

PubMed1989

Ligand-induced phosphorylation of a murine tumor surface protein (TSP-180) associated with metastatic phenotype.

A tumor surface protein (TSP-180) has been identified on murine lung carcinomas using two monoclonal antibodies (MoAbs) (135-13C and 346-11A). Quantitative analysis of TSP-180 on 3LL variants maintained either in vitro or in vivo indicates that TSP-180 is highly expressed in highly malignant metastatic cells. In reducing conditions, sodium dodecyl sulfate-polyacrylamide gel electrophoresis banding patterns of TSP-180 obtained with MoAb 135-13C from cell lysates of 3LL metastatic cells show three proteins migrating to Mr 204,000, 134,000, and 116,000. In the same experimental conditions MoAb 135-13C precipitates from low metastasizing ones only one band, corresponding to the lower molecular weight (Mr 116,000). All bands of TSP-180 observed in 3LL variants are labeled by lactoperoxidase-catalyzed radioiodination of viable cells, incorporate 32PO4, and contain carbohydrates, as judged by binding to wheat germ agglutinin. These results indicate that all proteins have external exposure on the cell surface and that at least some of TSP-180 proteins could be differentially regulated in different tumor cells (highly metastatic versus low metastatic). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis banding patterns and immunoblots obtained from cell lysates of 3LL variants by using a monoclonal antibody to phosphotyrosine (IG-2) indicate that this MoAb recognizes proteins migrating with molecular weights identical to those reported for TSP-180. Moreover, the immunoblots of solubilized immunocomplex, obtained from cell lysates of 3LL variants by using MoAb 135-13C, demonstrate that MoAb IG-2 specifically reacts with TSP-180 proteins. Experiments undertaken in order to assess if some or all of TSP-180 proteins have tyrosine kinase activity demonstrate that MoAb 135-13C binding to the cell surface induces specific phosphorylation of the Mr 204,000 protein of TSP-180. Phosphoaminoacid analysis of the ligand-induced phosphorylated protein (pp204) demonstrates that this protein is phosphorylated at serine and tyrosine. Results reported lead us to hypothesize that TSP-180 is involved in growth-regulation mechanisms and that its high expression on cells with more malignant phenotype could be responsible for a proliferative advantage of such tumor clones.

Amino Acids↗

PubMed1982

Ultrasonographic evaluation of hepatic metastases in testicular tumour.

The hundred and fifty-seven ultrasonographic examinations were carried out in 200 patients with testicular tumour. In 16 cases (8.0%) liver metastases were demonstrated. There were three main patterns: well- or ill-defined echopoor lesions, well-defined echogenic lesions, and "target" lesions. Echopoor liver lesions were found in metastatic seminoma, whilst metastatic teratoma may give any of these three patterns. The value of ultrasound for evaluating the therapeutic response of hepatic metastases from testicular tumour is discussed.

Adolescent↗

PubMed1978

[Extrarenal manifestations of renal cell carcinoma: the primary metastatic lesion (author's transl)].

In 18 patients, histologic evaluation of a solitary distant metastasis with characteristic hypernephroid pattern subsequently led to the diagnosis of renal cell carcinoma. The metastatic lesion was treated surgically in 15 cases; 14 patients underwent radical surgery and one patient with a solitary kidney underwent partial nephrectomy. Osseous metastases were predominant (12 out of 18). There was an excellent morphologic agreement between metastatic and primary lesions: in no case were metastases less differentiated than the primary tumor. Therefore in all cases of metastases with hypernephroid structures an aggressive search for renal malignancy is required. Five-year survival was 5% and identical to a group of 61 patients with metastases and a symptomatic renal cell carcinoma at diagnosis. The poor prognosis was not influenced by surgical extirpation of the solitary metastasis.

Adenocarcinoma↗

PubMed1999

Metastatic lymph-node clearance from head and neck epidermoid carcinomas following radiotherapy.

Although tumor clearance is a common criterion in assessing the impact of radiotherapy (RT), it is not always reliable. Patterns of tumor clearance were determined using 91 metastatic lymph nodes (LNs) from 51 patients with head and neck tumors treated by definitive RT (61-80 Gy) or preoperative RT (43-65 Gy). Clearance rate (CR) was estimated as a daily volume decrement expressed as a ratio to the pre-RT LN volume. CR was greater for the so-called radioresponsive nasopharyngeal subgroups and more poorly differentiated than those of oral cavity and well-differentiated, respectively. Histologically, LNs that were removed following RT consisted mainly of fibrous tissues, necrotic tissues, and few cancer cells. There was no difference in CR between the cancer-cell-positive group (n = 21) and the cancer-cell-negative group (n = 31). Although the CR may reflect inherent radiosensitivity of tumor cells, tumor persistence predicts the amount of oncologically inactive materials rather than that of remaining cancer cells.

Carcinoma, Squamous Cell↗

PubMed2005

[Clinical features of pathologically confirmed metastatic bone tumors--a report of 390 cases].

BACKGROUND & OBJECTIVE: With the development of diagnostic techniques of imaging and pathology, early diagnosis of metastatic bone tumors has been greatly improved, but the clinical characteristics which are essential for diagnosis are rarely reported. In this article, the clinical features of pathologically confirmed metastatic bone tumors were analyzed for further improvement of early diagnosis and treatment. METHODS: Clinical data of 390 patients with pathologically confirmed metastatic bone tumors, treated from 1980 to 2003 at The First Affiliated Hospital of Sun Yat-sen University, were reviewed respectively to summarize the clinical features, including disease history, predilection sites, clinical manifestation, and imaging presentations. RESULTS: Of the 390 patients, the ratio of men to women was 2.12:1; the median age was 55.7 years, and 81.5% of the patients were over 41 years old. The primary tumors were lung cancer (21.8%), prostate cancer (13.1%), breast cancer (7.4%), liver cancer (6.4%), gastrointestinal cancer (5.7%), and unknown cancers (24.6%). The common metastatic sites were spine (47.7%), pelvis (18.2%), femur (15.4%), and rib (12.6%). Multiple metastases occurred in 20.5% of the patients. The main symptoms were skeletal pain (53.3%), pathologic fractures (10.3%), dysfunction (4.9%), and paraplegia (2.1%). Primary tumor detected before metastasis accounted for 29.7% of the patients with a median metastatic time of 319 days, and the metastatic intervals were uncertain in 70.3% of the patients. Osteolytic types accounted for 80.7% of the cases in radiographic patterns, followed by osteosclerotic (10.5%) and mixed types. CONCLUSIONS: Metastatic bone tumors most frequently occur in patients older than 41 years, and commonly originate from lung, prostate, breast, and liver. Vertebrae, pelvis, femur, and rib are the most common sites of metastases. The clinical manifestation is extensive and nonspecific. Most lesions present osteolytic patterns. Metastases with unknown origin account for 24%. In spite of complexity, the clinical features should be mastered for early diagnosis and treatment.

Adolescent↗