Stage IV indicates metastatic disease to inguinal nodes on both sides or distant metastases. Tumour heterogeneity is commonly retained by tumor metastases. Local invasion of surrounding tissues or distant metastases indicate malignancy. The symptoms produced by metastatic breast cancer vary by the location of the metastases. The technique therefore is sensitive to fractures and bone reaction to bone tumors, including metastases. Breast cancer may invade directly through local spread, and through lymph node metastases. Another report of a malignant glomus tumor (glomangiosarcoma) with metastases from the skin. Sister Mary Joseph nodule is associated with multiple peritoneal metastases and a poor prognosis. More commonly, it is associated with ovarian metastases of intestinal cancer. In women with bone metastases, hypercalcemia may occur. He also had metastases in his peritoneal and retroperitoneal cavities. Symptomatic pituitary metastases account for only 7% of reported cases. There is evidence that surgery may be useful in select patients with recurrent brain metastases. Distant metastases to the lung are most common. CT advantages include its ability to demonstrate evidence of nearby organ invasion, ascites, and metastases.