CLINICAL IMAGE
Breast cancer with extensive bone metastasis mimicking myeloma Ya-Ting Hsu1 & Kung-Chao Chang2 1
Departments of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan Pathology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
2
Correspondence Kung-Chao Chang, Department of Pathology, National Cheng Kung University and Hospital, 138 Sheng-Li Road, Tainan, 704, Taiwan. Tel: +886-6-235-3535 ext. 2636; Fax: +886-6-276-6195; E-mail: [email protected]
Key Clinical Message
Funding Information No sources of funding were declared for this study.
Keywords
Punched-out lesions in skull film usually elicit consideration of myeloma. However, some other diseases cause similar clinical presentations. We describe an uncommon presentation of breast cancer, which mimics multiple myeloma. Therefore, in a broad spectrum of clinical settings, physicians should always consider differential diagnosis and await for definitive pathological diagnosis.
Breast cancer, metastasis, myeloma, punched-out, skull.
Received: 10 December 2015; Revised: 25 November 2016; Accepted: 17 December 2016 Clinical Case Reports 2017; 5(2): 203–204 doi: 10.1002/ccr3.817
Question A 52-years-old woman presented with progressive bone pain for 3 months. A skull film is shown in Fig. 1. Laboratory data exhibited normocytic anemia and elevated serum b2-microglobulin. What is your diagnosis?
Diagnosis Considering multiple myeloma, bone marrow examination was carried out and showed tumor cells arranged in solid nests (Fig. 2). Immunofixation electrophoresis was negative. Bone marrow biopsy showed metastatic carcinoma positive for estrogen receptor (Fig. 2) and progesterone receptor, consistent with invasive lobular carcinoma of breast. Chest CT revealed an ill-defined tumor (4.4 cm) occupying the outer aspect of right breast with multicentric appearance. Staging workup revealed bone metastasis without solid organ involvement. Currently, the patient is undergoing chemotherapy, hormone therapy, and bisphosphonate with relief of back pain.
Figure 1. X-ray of skull bone shows multiple punched-out lesions (arrows).
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
203
Metastatic breast cancer mimicking myeloma
(A)
Y.-T. Hsu & K.-C. Chang
(B)
(C)
Figure 2. (A) Bone marrow smear shows tumor cells arranged in solid nests with nuclear hyperchromatism (Liu stain, 10009). (B) Bone marrow biopsy reveals cell nests of metastatic carcinoma (H&E stain, 4009). (C) Immunohistochemically, the tumor cells express estrogen receptor (red color, hematoxylin counterstain, 4009).
Authorship
Conflict of Interest
Hsu YT: wrote the article. Chang KC: supervised and wrote the article.
None declared.
204
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
Breast cancer with extensive bone metastasis mimicking myeloma Ya-Ting Hsu1 & Kung-Chao Chang2 1
Departments of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan Pathology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
2
Correspondence Kung-Chao Chang, Department of Pathology, National Cheng Kung University and Hospital, 138 Sheng-Li Road, Tainan, 704, Taiwan. Tel: +886-6-235-3535 ext. 2636; Fax: +886-6-276-6195; E-mail: [email protected]
Key Clinical Message
Funding Information No sources of funding were declared for this study.
Keywords
Punched-out lesions in skull film usually elicit consideration of myeloma. However, some other diseases cause similar clinical presentations. We describe an uncommon presentation of breast cancer, which mimics multiple myeloma. Therefore, in a broad spectrum of clinical settings, physicians should always consider differential diagnosis and await for definitive pathological diagnosis.
Breast cancer, metastasis, myeloma, punched-out, skull.
Received: 10 December 2015; Revised: 25 November 2016; Accepted: 17 December 2016 Clinical Case Reports 2017; 5(2): 203–204 doi: 10.1002/ccr3.817
Question A 52-years-old woman presented with progressive bone pain for 3 months. A skull film is shown in Fig. 1. Laboratory data exhibited normocytic anemia and elevated serum b2-microglobulin. What is your diagnosis?
Diagnosis Considering multiple myeloma, bone marrow examination was carried out and showed tumor cells arranged in solid nests (Fig. 2). Immunofixation electrophoresis was negative. Bone marrow biopsy showed metastatic carcinoma positive for estrogen receptor (Fig. 2) and progesterone receptor, consistent with invasive lobular carcinoma of breast. Chest CT revealed an ill-defined tumor (4.4 cm) occupying the outer aspect of right breast with multicentric appearance. Staging workup revealed bone metastasis without solid organ involvement. Currently, the patient is undergoing chemotherapy, hormone therapy, and bisphosphonate with relief of back pain.
Figure 1. X-ray of skull bone shows multiple punched-out lesions (arrows).
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
203
Metastatic breast cancer mimicking myeloma
(A)
Y.-T. Hsu & K.-C. Chang
(B)
(C)
Figure 2. (A) Bone marrow smear shows tumor cells arranged in solid nests with nuclear hyperchromatism (Liu stain, 10009). (B) Bone marrow biopsy reveals cell nests of metastatic carcinoma (H&E stain, 4009). (C) Immunohistochemically, the tumor cells express estrogen receptor (red color, hematoxylin counterstain, 4009).
Authorship
Conflict of Interest
Hsu YT: wrote the article. Chang KC: supervised and wrote the article.
None declared.
204
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
