Exploring unconventional sites of bone metastasis: a comprehensive exploration of common and uncommon tumors in the Lesser-Known realms

Abstract Introduction Bone metastases rank third in prevalence among metastatic afflictions, following lung and liver. Historically linked to breast, prostate, and lung cancers, evolving cancer therapies now reveal skeletal metastasis in diverse cancer types previously not associated with it. This study delves into unique cases of bone metastasis received over a year in a specialized lab dealing with soft tissue and bone specimens. It explores the challenges associated with diagnosing such atypical occurrences. Materials and Methods Examining 1230 bone biopsies received between January 1, 2023, and December 31, 2023, we focused on rare secondary bone malignancies, excluding benign pathologies and primary bone malignancies. Results Following meticulous adherence to the predefined inclusion and exclusion criteria, a comprehensive cohort of 14 cases became the focal point of this study. Within this cohort, the gender distribution revealed 9 female and 5 male participants. Notably, among the subjects, 4 were aged above 60 years, while the remaining 10 were below this age threshold. The predominant bone metastasis originated from Follicular Thyroid Carcinoma, reported in 3 cases (21.4%). 7 (50%) cases had bone metastasis as an initial presentation of occult primaries. Metastasis manifested in 9 cases within the appendicular skeleton and 5 cases within the axial skeleton. Further granularity within the appendicular skeleton revealed the humerus as the most prevalent site of metastasis, closely trailed by the femur in frequency. Conclusion This study highlights the diagnostic challenges of rare secondary bone malignancies, with half of the cases presenting as the first sign of occult cancers. Bone metastases were most common in the humerus and femur, emphasizing the need for thorough evaluation of unexplained bone lesions.