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Carcinomatous osteodysplasia

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Abstract

The cancellous bone of the skeleton usually shows striking alterations when metastatic carcinoma has involved the bone marrow. These changes, termed carcinomatous osteodysplasia (COD), have been analyzed in 1164 iliac crest biopsies of unselected patients with a variety of primary tumours. Semithin (3 μ) sections of undecalcified biopsies embedded in methacrylate were examined for foreign cells. Metastases were found in 462 of the 1164 biopsies and 91% of these, as well as 17% of the negative biopsies, showed some degree of COD. Osteodysplasia was more frequent in biopsies of patients with signs of systemic spread than in those without.

COD includes a variable, local increase in active osteoblasts and osteoclasts, in blood vessels and in other stromal tissues. The incidence of COD was higher in the adenomatous and scirrhous metastases than in the other histological varieties. COD was subdivided into primarily osteolytic, osteosclerotic, and mixed types, and five different forms of bone resorption and formation were identified. These forms showed a characteristic association with the degree of mesenchymal activation on the one hand and the structural type of the metastases on the other, and correlated with certain cytological characteristics of the neoplastic cells.

We conclude that COD is a significant consequence of the biological activities of metastatic cancer and it is readily accesible for observation by bone biopsy. The morphological classification of COD proposed in this study provides a basis for further investigation.

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Authors and Affiliations

  1. Abteilung für Knochenmarksdiagnostik, Medizinische Klinik Innenstadt der Universität München, Münich, FRG

    R. Burkhardt M.D.

  2. Abteilung Hämatomorphologie, Institut für Hämatologie der Gesellschaft für Strahlen-und Umweltforschung mbH, Munich, FRG

    R. Burkhardt M.D., R. Schlag M.D. & W. Sommerfeld

  3. Institute for Hematology, Tel-Aviv Municipal Governmental Medical Center, Tel-Aviv, Israel

    B. Frisch M.D.

Authors
  1. R. Burkhardt M.D.
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  2. B. Frisch M.D.
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  3. R. Schlag M.D.
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  4. W. Sommerfeld
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Burkhardt, R., Frisch, B., Schlag, R. et al. Carcinomatous osteodysplasia. Skeletal Radiol 8, 169–178 (1982). https://doi.org/10.1007/BF00355501

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