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Bone metastases of unknown origin: epidemiology and principles of management

ABSTRACT: Metastases are the most common malignancies involving bone; breast, prostate, lung and thyroid are the main sites of primary cancer. However, up to 30 % of patients present with bone metastases of unknown origin, where the site of the primary neoplasm cannot be identified at the time of di...

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Autores principales: Piccioli, Andrea, Maccauro, Giulio, Spinelli, Maria Silvia, Biagini, Roberto, Rossi, Barbara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441638/
https://www.ncbi.nlm.nih.gov/pubmed/25726410
http://dx.doi.org/10.1007/s10195-015-0344-0
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author Piccioli, Andrea
Maccauro, Giulio
Spinelli, Maria Silvia
Biagini, Roberto
Rossi, Barbara
author_facet Piccioli, Andrea
Maccauro, Giulio
Spinelli, Maria Silvia
Biagini, Roberto
Rossi, Barbara
author_sort Piccioli, Andrea
collection PubMed
description ABSTRACT: Metastases are the most common malignancies involving bone; breast, prostate, lung and thyroid are the main sites of primary cancer. However, up to 30 % of patients present with bone metastases of unknown origin, where the site of the primary neoplasm cannot be identified at the time of diagnosis despite a thorough history, physical examination, appropriate laboratory testing and modern imaging technology (CT, MRI, PET). Sometimes only extensive histopathological investigations on bone specimens from biopsy can suggest the primary malignancy. At other times, a bone lesion can have such a highly undifferentiated histological appearance that a precise pathological classification on routine hematoxylin–eosin-stained section is not possible. The authors reviewed the relevant literature in an attempt to investigate the epidemiology of the histological primaries finally identified in patients with bone metastases from occult cancer, and a strategy of management and treatment of bone metastases from occult carcinomas is suggested. Lung, liver, pancreas and gastrointestinal tract are common sites for primary occult tumors. Adenocarcinoma is the main histological type, accounting for 70 % of all cases, while undifferentiated cancer accounts for 20 %. Over the past 30 years, lung cancer is the main causative occult primary for bone metastases and has a poor prognosis with an average survival of 4–8 months. Most relevant literature focuses on the need for standardized diagnostic workup, as surgery for bone lesions should be aggressive only when they are solitary and/or the occult primaries have a good prognosis; in these cases, identification of the primary tumor may be important and warrants special diagnostic efforts. However, in most cases, the primary site remains unknown, even after autopsy. Thus, orthopedic surgery has a mainly palliative role in preventing or stabilizing pathological fractures, relieving pain and facilitating the care of the patient in an attempt to provide the most appropriate therapy for the primary tumor as soon as possible. LEVEL OF EVIDENCE: 5
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spelling pubmed-44416382015-05-28 Bone metastases of unknown origin: epidemiology and principles of management Piccioli, Andrea Maccauro, Giulio Spinelli, Maria Silvia Biagini, Roberto Rossi, Barbara J Orthop Traumatol Review Article ABSTRACT: Metastases are the most common malignancies involving bone; breast, prostate, lung and thyroid are the main sites of primary cancer. However, up to 30 % of patients present with bone metastases of unknown origin, where the site of the primary neoplasm cannot be identified at the time of diagnosis despite a thorough history, physical examination, appropriate laboratory testing and modern imaging technology (CT, MRI, PET). Sometimes only extensive histopathological investigations on bone specimens from biopsy can suggest the primary malignancy. At other times, a bone lesion can have such a highly undifferentiated histological appearance that a precise pathological classification on routine hematoxylin–eosin-stained section is not possible. The authors reviewed the relevant literature in an attempt to investigate the epidemiology of the histological primaries finally identified in patients with bone metastases from occult cancer, and a strategy of management and treatment of bone metastases from occult carcinomas is suggested. Lung, liver, pancreas and gastrointestinal tract are common sites for primary occult tumors. Adenocarcinoma is the main histological type, accounting for 70 % of all cases, while undifferentiated cancer accounts for 20 %. Over the past 30 years, lung cancer is the main causative occult primary for bone metastases and has a poor prognosis with an average survival of 4–8 months. Most relevant literature focuses on the need for standardized diagnostic workup, as surgery for bone lesions should be aggressive only when they are solitary and/or the occult primaries have a good prognosis; in these cases, identification of the primary tumor may be important and warrants special diagnostic efforts. However, in most cases, the primary site remains unknown, even after autopsy. Thus, orthopedic surgery has a mainly palliative role in preventing or stabilizing pathological fractures, relieving pain and facilitating the care of the patient in an attempt to provide the most appropriate therapy for the primary tumor as soon as possible. LEVEL OF EVIDENCE: 5 Springer International Publishing 2015-03-01 2015-06 /pmc/articles/PMC4441638/ /pubmed/25726410 http://dx.doi.org/10.1007/s10195-015-0344-0 Text en © The Author(s) 2015 https://creativecommons.org/licenses/by/4.0/ Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Review Article
Piccioli, Andrea
Maccauro, Giulio
Spinelli, Maria Silvia
Biagini, Roberto
Rossi, Barbara
Bone metastases of unknown origin: epidemiology and principles of management
title Bone metastases of unknown origin: epidemiology and principles of management
title_full Bone metastases of unknown origin: epidemiology and principles of management
title_fullStr Bone metastases of unknown origin: epidemiology and principles of management
title_full_unstemmed Bone metastases of unknown origin: epidemiology and principles of management
title_short Bone metastases of unknown origin: epidemiology and principles of management
title_sort bone metastases of unknown origin: epidemiology and principles of management
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441638/
https://www.ncbi.nlm.nih.gov/pubmed/25726410
http://dx.doi.org/10.1007/s10195-015-0344-0
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