Mixed lytic and sclerotic bone metastases
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The diagnosis is established by proof of sclerotic and lytic bone metastases of one primary tumor or both components in the same distant tumor deposit.
Mixed lytic and sclerotic bone metastases are characterized by the presence of both components, that is areas of bone destruction and areas of increased bone formation within one metastatic tumor deposit or one primary tumor that features both kinds of bone metastases, namely osteolytic and osteoblastic metastases 1.
Mixed lytic and sclerotic bone metastases are seen in several primary malignancies including 1-3:
- breast carcinoma: typically sclerotic but 25% are mixed
- lung carcinoma: typically lytic but 15% are mixed
- carcinoma of the cervix
- testicular tumors
- prostate carcinoma: typically sclerotic but 15% are mixed
- ganglioneuroblastoma: in pediatric patients 4
- gastrointestinal cancers
- squamous cell carcinomas
Imaging characteristics of mixed lytic and sclerotic bone metastases consist of a mixture of both which means the presence of radiodense and lytic areas within one metastasis or the presence of radiodense and radiolucent areas.
Appearances will be that of a mixed density bone lesion or the coexistence of sclerotic and lucent bone lesions 5.
- T1: low signal
- T2: variable to hyperintense
- DWI: diffusion restriction
The radiological report should include a description of the following 2:
- presence of lytic and sclerotic components or metastases
- location and size including the whole extent of disease load
- aggressive features
Treatment and prognosis
See article: bone metastases
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