J Korean Soc Magn Reson Med.  2014 Mar;18(1):59-63. 10.13104/jksmrm.2014.18.1.59.

SAPHO Syndrome in a Patient with Breast Cancer Mimicking Bone Metastasis: A Case Report

• Ko K
• Suh HJ
• You JY
• Jung SY
• Kwon Y
• Koh YW

• KMID: 1683781
• DOI: http://doi.org/10.13104/jksmrm.2014.18.1.59

Abstract

A 66-year-old woman was transferred to our hospital due to her right breast cancer. Preoperative breast MRI shows 1.9 cm malignancy on her right breast (cT1N0M0) and incidentally found osteosclerotic change of left coststernoclavicular region. Bone scintigraphy showed hot uptake and the possibility of bone metastasis was not excluded. However, because the bone metastasis is not common in early stage cancer and the costosternoclavicular region is not common site, other possibility should be considered. SAPHO syndrome can be diagnosed even in the absence of dermatosis when there is an axial or appendicular osteitis and hyperostosis, especially in costosternoclavicular region. Though breast imaging specialists are not accustomed to this disease entity, awareness and diagnosis of the SAPHO syndrome can help differentiate bone metastasis.

Keyword

Breast cancer; SAPHO syndrome; Costosternoclavicular region

MeSH Terms

Acquired Hyperostosis Syndrome*
Aged
Breast Neoplasms*
Breast*
Diagnosis
Female
Humans
Hyperostosis
Magnetic Resonance Imaging
Neoplasm Metastasis*
Osteitis
Radionuclide Imaging
Skin Diseases
Specialization

Figure

• 

  Fig. 1 Imaging findings in a 66-year-old woman with her right breast cancer. a. On breast ultrasound, about 1.3 cm-sized irregular mass is seen (hollow arrow) at her right breast which was confirmed as an invasive ductal carcinoma via gun biopsy. b. Breast MRI shows sclerotic bone changes of her left sternoclavicular joint (hollow arrows). On T2 weighted image, mild high signal intensities on the marrows of her left clavicle and manubrium (hollow arrow) are accompanied (top image) and on T1 weighted image, sclerotic cortical change is seen (white arrow, bottom image). c. Bone scintigraphy shows hot uptake at left costosternoclavicular region (hollow arrow). d. The osteosclerotic changes of left sternoclavicular region are seen on CT (right side, hollow arrow). To obtain the pathology, a bone biopsy needle (left side, white arrow) was advanced under CT guidance and chronic active inflammation without causative organism was confirmed. e. The chondro-osseous tissue is infiltrated by many inflammatory cells mainly composed of neutrophils and lymphocytes (× 100, H & E stain).

Reference

1. Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN, Ueno NT. Bone imaging in metastatic breast cancer. J Clin Oncol. 2004; 22:2942–2953.

2. Coleman RE, Rubens RD. The clinical course of bone metastases from breast cancer. Br J Cancer. 1987; 55:61–66.

3. Hortobagyi GN. Bone metastases in breast cancer patients. Semin Oncol. 1991; 18:11–15.

4. Boutin RD, Resnick D. The sapho syndrome: an evolving concept for unifying several idiopathic disorders of bone and skin. AJR Am J Roentgenol. 1998; 170:585–591.

5. Rubens RD. Bone metastases--the clinical problem. Eur J Cancer. 1998; 34:210–213.

6. Reith JD, Bauer TW, Schils JP. Osseous manifestations of sapho (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. Am J Surg Pathol. 1996; 20:1368–1377.

7. Assmann G, Simon P. The sapho syndrome--are microbes involved? Best Pract Res Clin Rheumatol. 2011; 25:423–434.

8. Chamot AM, Vion B, Gerster JC. Acute pseudoseptic arthritis and palmoplantar pustulosis. Clin Rheumatol. 1986; 5:118–123.

9. Sonozaki H, Mitsui H, Miyanaga Y, et al. Clinical features of 53 cases with pustulotic arthro-osteitis. Ann Rheum Dis. 1981; 40:547–553.

10. Hellmann DB. Spondyloarthropathy with hidradenitis suppurativa. JAMA. 1992; 267:2363–2365.