Neoplastic disease of the bones is not uncommon. It has been claimed that up to 80% of patients with carcinomas have metastasis to the bones.1 The most common primaries are breast, lung and prostate with the most common locations being the spine, ribs, pelvis and femur.

A much rarer entity is the primary sarcoma of bone. In the United States, approximately 2,440 new cases of primary bone sarcomas are identified annually.2 Of these, 5% affect the pelvic girdle with the most common primaries being Ewing's sarcoma (children), Osteosarcoma (adolescents) and Chondrosarcoma (adults).3

The treatment of pelvic neoplasms varies depending not only cell type, but also location, the patient's physical and psychological status as some of these procedures require long hospitalizations and lengthy rehabilitation.

Fortunately, many pelvic lesions can be treated (including small lesions of the acetabulum) locally with surgery, radiotherapy and/or neoadjuvant therapy. This can be curative in the patient with primary neoplasia and can be palliative in patients with metastatic disease.

However, in certain cases, larger more extensive lesions require more extensive reconstruction to cure, relieve pain, or maintain functionality.

Thyroid metastasis to right acetabulum. T2 weighted:

With advances in implant and surgical technology, expectations of surgeons and patients are increasing. Limb preservation without reasonable function is no longer satisfactory for most patients.4 

Renal Cell Carcinoma metastasis to left acetabulum.

Extensive renal cell carcinoma to left acetabulum. Same patient as above.

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