class="Heading">Abstract class="Para">Metastases are the most common malignancies involving bone; breast, prostate, lung and thyroid are the main sites of primary cancer. However, up to 30?% of patients present with bone metastases of unknown origin, where the site of the primary neoplasm cannot be identified at the time of diagnosis despite a thorough history, physical examination, appropriate laboratory testing and modern imaging technology (CT, MRI, PET). Sometimes only extensive histopathological investigations on bone specimens from biopsy can suggest the primary malignancy. At other times, a bone lesion can have such a highly undifferentiated histological appearance that a precise pathological classification on routine hematoxylin–eosin-stained section is not possible. The authors reviewed the relevant literature in an attempt to investigate the epidemiology of the histological primaries finally identified in patients with bone metastases from occult cancer, and a strategy of management and treatment of bone metastases from occult carcinomas is suggested. Lung, liver, pancreas and gastrointestinal tract are common sites for primary occult tumors. Adenocarcinoma is the main histological type, accounting for 70?% of all cases, while undifferentiated cancer accounts for 20?%. Over the past 30?years, lung cancer is the main causative occult primary for bone metastases and has a poor prognosis with an average survival of 4–8?months. Most relevant literature focuses on the need for standardized diagnostic workup, as surgery for bone lesions should be aggressive only when they are solitary and/or the occult primaries have a good prognosis; in these cases, identification of the primary tumor may be important and warrants special diagnostic efforts. However, in most cases, the primary site remains unknown, even after autopsy. Thus, orthopedic surgery has a mainly palliative role in preventing or stabilizing pathological fractures, relieving pain and facilitating the care of the patient in an attempt to provide the most appropriate therapy for the primary tumor as soon as possible. class="Heading">Level of evidence class="Para">5
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机译：class =“ Heading”>摘要 class =“ Para”>转移灶是涉及骨骼的最常见的恶性肿瘤。乳腺癌，前列腺癌，肺癌和甲状腺癌是原发癌的主要部位。但是，多达30％的患者存在骨来源不明的骨转移，尽管有详尽的病史，体格检查，适当的实验室测试和现代影像学检查技术，但在诊断时仍无法确定原发性肿瘤的部位（CT， MRI，PET）。有时，仅对来自活检的骨标本进行广泛的组织病理学检查才能提示原发性恶性肿瘤。在其他时候，骨病变可能具有高度未分化的组织学外观，因此无法对常规苏木精-伊红染色的切片进行精确的病理分类。作者回顾了相关文献，试图调查在隐匿性癌的骨转移患者中最终鉴定出的组织学原发病的流行病学，并提出了管理和治疗隐匿性癌的骨转移的策略。肺，肝，胰腺和胃肠道是原发性隐匿性肿瘤的常见部位。腺癌是主要的组织学类型，占所有病例的70％，而未分化癌占20％。在过去的30年中，肺癌是导致骨转移的主要隐匿原因，预后较差，平均生存期为4-8个月。大多数相关文献集中在对标准化诊断检查的需求上，因为仅在骨病变孤立和/或隐匿性原发灶预后良好时，才应积极进行骨病变的手术。在这些情况下，对原发肿瘤的识别可能很重要，需要特殊的诊断工作。但是，在大多数情况下，即使经过尸检，主部位仍然是未知的。因此，整形外科在预防或稳定病理性骨折，减轻疼痛和促进患者护理方面具有主要的姑息作用，试图尽早为原发性肿瘤提供最合适的治疗。 class =“ Heading”>证据水平 class =“ Para”> 5
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