Bone metastases – 10 years clinicopathologic experience

Abstract

Background & Objective: Bones are the third most frequent site of metastases which are radiologically characterized as osteolytic, osteosclerotic and mixed. The aim of this study was to make clinicopathologic characterization of the patients with bone metastasis (BM) and to correlate osteoblastic and osteoclastic activity with the metastasis type. Method: We analyzed 80 patients with BM who underwent surgical therapy, for demographic data, radiological types, primary tumour, localization, pathological fracture and survival. Microscopically, we analyzed 10 high power fields of the densest metastatic deposition areas. We used semi-quantitative method to determine the density of bony trabeculae osteoblast rimming and the osteoclasts’ density in Howship’s lacunae, categorizing it as mild, moderate and high. Similarly, we determined the thickness of the trabeculae and osteoid. Results: There were 55 osteolytic, 11 osteosclerotic and 14 mixed metastases. The commonest primary site for osteolytic metastases was the mammary gland and for osteosclerotic was the prostate gland. The most affected bone was the femur. Pathological fracture was present in 49 patients. The mean survival time was 16,42 months. The density of osteoclasts was significantly higher in osteolytic metastases (p<0,01), the density of osteoblastic rimming was non-significantly higher in osteosclerotic metastases, and the bony trabeculae and osteoid were non-significantly thicker in osteosclerotic metastases. Mixed MS showed prevalence of one or other type of activity without significant difference. There was significant correlation between the radiological and histological findings (p<0,05). Conclusion: We found that the histological pattern of bone reaction correlates to the radiographical findings and the osteoclastic was the main activity in BM.