Bone metastasis as the first symptom of tumors: role of an immunohistochemistry study in establishing primary tumor

Abstract

ObjectivesTo determine the role of immunohistochemistry in identifying the primary site of tumors, and in establishing which bones are most frequently involved, their relationship with the primary tumor site, and the rate of pathologic bone fracture as the first symptom of a malignant tumor.MethodsA retrospective analysis of all medical records on bone metastases the cases treated between January 2006 and December 2011 at the Department of Orthopedics and Traumatology was performed.ResultsImmunohistochemistry correctly determined the primary tumor site in 61.2% of cases analyzed. Regarding the metastatic site, the most affected bone was the femur, accounting for 49.6% of the sample. Bone metastasis was the first symptom of the tumor in only 20.2% of patients, and of these, 95% were admitted for pathologic bone fracture.ConclusionThe study showed that the primary sites and their incidence rate are consistent with the literature reviewed. It was noted that in this sample, most patients did not present with pathologic bone fracture as the first clinical symptom of neoplastic disease. However, analysis of those patients that had a metastasis as the first clinical symptom revealed that it manifested itself as a pathologic fracture in almost all cases. The immunohistochemical study was consistent with the primary tumor site in most cases, indicating the value of the method in the detection of the primary site.

Outcomes and survival of spinal metastasis with epidural compression

“…[ 1 2 4 ] The thoracic spine was the most frequent location, and breast and prostate spinal metastases were the most frequently observed primary tumor in our patients and other reports of the same country. [ 10 11 13 15 16 19 ] Contrary to what was reported in other countries, metastases of primary lung tumor were less frequent in our patients as well as in local reports. [ 10 13 15 19 20 ] This finding may be related to the lack of target therapies in our country, which has increased the survival of these patients.…”

“…[ 11 12 13 ] The therapeutic decision of spinal metastases has considered the nature of the primary tumor, the patient's overall clinical condition, neurological status, and survival scales. [ 1 7 14 15 16 ] However, it is very difficult to predict the prognosis of a patient with spinal metastasis and choose the best treatment option.…”

Increased thyroglobulin and receptor activator of nuclear factor kappa B ligand expression is a risk factor of bone metastasis on patients with thyroid cancer

“…In general, it is a useful modality in the diagnosis of MBD, especially for determining the primary tumor of these metastases. 15 Study by Ramos-Vara et al regarding the detection of thyroid transcription factor-1 (TTF-1), thyroglobulin and calcitonin by histochemical methods in normal, hyperplastic and neoplastic canine thyroid glands shows that detection of Tg and calcitonin can be used in conjunction with detection of TTF-1 to improve the ability to detect the presence and differentiation of thyroid tumors and their metastases. 16 On the other hand, research by Zakavi et al showed that thyroglobulin expression is not directly related to the incidence rate of MBD in the case of bone metastases of patients with thyroid cancer.…”