Introduction Metastatic cancer is the most common reason for a destructive bone lesion in adults login to view 7 more bullets Metastatic hypercalcemia login to view 2 more bullets epidemiology Age & location login to view 5 more bullets etiology Mechanism login to view 12 more bullets Presentation Symptoms login to view 9 more bullets Physical exam login to view 2 more bullets Imaging Radiographic characteristics login to view 6 more bullets studies Workup for older patient with single bone lesion and unknown primary includes login to view 11 more bullets Histology login to view 6 more bullets Treatment Nonoperative login to view 8 more bullets Operative login to view 6 more bullets Differentials & Groups Malignant lesion in older patient(1)Multiple lesion in older patient(1)Epithelial glands on histologyBenefits from Bisphonate therapyTreatment is wide resection and radiation(2)Metastatic bone disease•••••Myeloma•••Lymphoma••Chondrosarcoma•MFH / fibrosarcoma•Secondary sarcoma•Pagets disease••Fibrous dysplasia•Synovial sarcoma•Hyperparathyroidism•Gomus tumor•Soft tissue sarcomas(3)•ASSUMPTIONS: (1) Older patient is > 40 yrs; (2) assuming no impending fracture (3) High-grade soft tissue sarcomas includes angiosarcoma, synovial sarcoma, liposarcoma, desmoid tumor, MFH/fibrosarcoma: exception is rhabdomysarcoma which is treated with chemotherapy and wide resection LocationXrayXrayCTB. ScanMRIMRIHisto(1)Case Aprox femurCase BpelvisCase Chand (thyroid CA)Case Dhand (lung CA)Case Efemur (lung CA)Case FpelvisCase Grenal CA (angio) Prognosis Median survival in patients with metastatic bone disease login to view 5 more bullets