What general pattern of distribution do skeletal metastases follow? Why?
The distribution of skeletal metastases roughly mirrors the distribution of red-marrow, presumably reflecting increased blood flow in red-marrow compared to yellow-marrow. Metastases are thus usually found in: vertebrae (especially posterior vertebral body, extending into pedicles); pelvis; proximal femur; proximal humerus; skull.
What are the most common primary malignancies to result in skeletal metastases? Which is this patient likely to have?
Lung cancer, breast cancer, renal cell carcinoma and prostate cancer account for approximately 80% of all skeletal metastases. Of these this patient is most likely to have metastases from breast cancer, although another less common malignancy should also be considered.
What general management statements can be made about skeletal metastases?
In general patients are treated systemically for metastatic disease, with localised radiotherapy used in some instances. When metastases involve the majority of the cross section of a bone, especially in structurally critical bones such as the femur, prophylactic pinning / internal fixation may be required to prevent a pathological fracture.
Follow up radiograph obtained 2 months later demonstrates an obviously aggressive lesion with a soft tissue component destroying the outer third of the clavicle. The acromium and coracoid appear intact. No other destructive lesions are evident.