Metastatic Tumors



Metastatic Tumors


Dina R. Mody, MD





Key Facts


Clinical Issues



  • Most common primary sites are lung, breast, prostate, kidney, and thyroid


  • Predilection for regions containing red marrow


  • Commonly involved bones include skull, spine, ribs, pelvis, humerus, and femur


  • Pain is typical presenting symptom of skeletal metastases


Cytopathology



  • Usually cellular; however, can be bloody and hypocellular


  • Epithelial, cohesive cells in carcinomas


  • Crush effect and chromatin streaking: Think small cell carcinoma/lymphoma


  • Clear cells: Consider renal cell, lung


  • In general, metastases try to imitate primary







Pap stain of metastatic prostate carcinoma shows cribriform pattern characterized by punched-out intrasheet lumina image. The cells are cohesive in sheets and clearly do not belong in the bone.






Pap stain shows a large syncytial cluster of malignant cells with abrupt keratinization image that indicates the squamous nature of this poorly differentiated carcinoma.


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Far more common than primary bone tumors (25:1)


    • Most common primary sites are lung, breast, prostate, kidney, and thyroid



      • Other tumors include lymphoma, melanoma, neuroendocrine carcinoma (NEC), and hepatocellular carcinoma


      • Rarely, osteosarcoma shows bone-to-bone metastasis


    • After lungs and liver, skeleton is 3rd most frequent site of metastatic disease


    • ˜ 40-90% of patients with advanced carcinoma have skeletal metastases during course of disease


  • Age



    • More common in elderly population


Site



  • Predilection for regions containing red marrow


  • Commonly involved bones include skull, spine, ribs, pelvis, humerus, and femur


  • Metastases distal to knee and tibia are rare



    • Distal metastases are typically from lung


  • In long bones, metastatic deposits tend to involve metaphysis



    • Solitary metastasis in long bones may mimic primary sarcoma


Presentation



  • Pain is a typical presenting symptom of skeletal metastases


  • Pathologic fracture


  • Neurological symptoms with spinal metastasis


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Jul 6, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Metastatic Tumors

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