A 50-year-old woman with known breast carcinoma presents with severe back pain. X-ray shows collapse of D9 vertebra with a lytic lesion. Nuclear bone scan shows multiple 'hot spots.' This is consistent with metastatic bone disease. Compared to multiple myeloma, metastatic carcinoma typically produces which type of bone lesion most commonly?
- A Purely lytic lesions in all cases
- B Purely sclerotic lesions
- C Mixed lytic and sclerotic lesions (especially with breast and prostate metastases) ✓
- D No X-ray change visible until >75% bone loss
Correct answer: C. Mixed lytic and sclerotic lesions (especially with breast and prostate metastases)
Explanation
Metastatic bone lesions can be lytic (kidney, thyroid, lung, colon metastases), sclerotic (prostate carcinoma — purely blastic), or mixed (breast carcinoma — often mixed lytic-sclerotic). Prostate metastases are classically sclerotic (osteoblastic). Multiple myeloma produces purely lytic 'punched-out' lesions with no surrounding sclerosis and is characteristically cold on bone scan (unlike metastases). Breast metastases are classically mixed. Recognition of these patterns on X-ray and bone scan is a classic NEET PG topic in radiology-orthopedics overlap.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.