Mixed lytic and sclerotic bone (osteolytic and osteoblastic) metastases refer to metastatic bone disease with both sclerotic and lytic bone metastases or bone metastases with both components.
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Diagnosis
The diagnosis is established by proof of sclerotic and lytic bone metastases of one primary tumour or both components in the same distant tumour deposit.
Pathology
Mixed lytic and sclerotic bone metastases are characterised by the presence of both components, that is areas of bone destruction and areas of increased bone formation within one metastatic tumour deposit or one primary tumour that features both kinds of bone metastases, namely osteolytic and osteoblastic metastases 1.
Aetiology
Mixed lytic and sclerotic bone metastases are seen in several primary malignancies including 1-3:
breast carcinoma: typically lytic but 10% are mixed
lung carcinoma: typically lytic but 15% are mixed
prostate carcinoma: typically sclerotic but 15% are mixed
ganglioneuroblastoma: in paediatric patients 4
gastrointestinal cancers
squamous cell carcinomas
Radiographic features
Plain radiograph
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.
CT
Appearances will be that of a mixed density bone lesion or the coexistence of sclerotic and lucent bone lesions 5.
MRI
Signal characteristics
T1: low signal
T2: variable to hyperintense
DWI: diffusion restriction
Radiology report
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
cortical destruction/breach
soft tissue extension
aggressive periosteal reaction
pain attributable to the lesion (if known)
Treatment and prognosis
See article: bone metastases
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