J Breast Cancer.  2016 Mar;19(1):87-91. 10.4048/jbc.2016.19.1.87.

Metastatic Osteosarcoma to the Breast Presenting as a Densely Calcified Mass on Mammography

• Kim J
• Woo HY
• Kim EK
• Kim MJ
• Moon HJ
• Yoon JH

• KMID: 2176326
• DOI: http://doi.org/10.4048/jbc.2016.19.1.87

Abstract

Osteosarcoma most commonly metastasizes to the lung or the skeleton, and metastatic osteosarcoma to the breast is very rare, with only a few cases reported. Due to its rarity, little has been reported about its imaging features. In this report, we represent a 58-year-old woman with metastatic osteosarcoma to the right breast from a tibial osteosarcoma. The imaging features of the metastatic osteosarcoma to the breast by using dedicated breast imaging modalities are described. Although rare, metastatic osteosarcoma to the breast should be considered when dense calcified masses with suspicious features are seen on breast imaging in patients with a history of osteosarcoma.

Keyword

Breast; Mammography; Neoplasm metastasis; Osteosarcoma; Ultrasonography

MeSH Terms

Breast*
Female
Humans
Lung
Mammography*
Middle Aged
Neoplasm Metastasis
Osteosarcoma*
Skeleton
Ultrasonography

Figure

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  Figure 1 Magnetic resonance imaging and pathologic features of the osteosarcoma involving the right tibia. (A) A 4.8-cm-sized osteosclerotic mass (arrows) with periosteal reaction is seen in the diaphysis of the right distal tibia. (B) This mass was diagnosed as conventional osteosarcoma, osteoblastic type, showing lacy architectural pattern on excisional biopsy (H&E stain, ×200).

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  Figure 2 Metastatic osteosarcoma detected on chest computed tomography (CT). (A) Two calcified masses were seen on initial chest CT, one in the right breast, and one at the anterior mediastinum (arrows). (B) Follow-up chest CT performed 3 weeks later revealed size increase of these masses, breast mass from 11 to 14 mm and mediastinal mass from 12 to 15 mm (arrows), raising the suspicion for metastasis.

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  Figure 3 Mammography and breast ultrasonography (US) examinations of the right breast mass. (A) Mediolateral oblique views of mammography show a dense calcified mass (arrow) with spiculated margins in the right upper breast. (B) Breast US performed on the same day shows a 1.5-cm dense calcified mass with posterior shadowing. Percutaneous biopsy was considered difficult due to the dense calcifications, and the patient underwent excisional biopsy.

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  Figure 4 Specimen mammography and the pathology features of the right breast mass. (A) Specimen mammography reveals the dense calcified mass (arrows) seen on mammography in the right breast, confirming complete excision of the mass. (B) Similar features are seen on gross specimen, which reveals a dense calcified mass within the breast tissue. (C) Microscopic examination shows a mass with predominant osteoid matrix production (arrows) (H&E stain, ×40). (D) Immunohistochemically, these tumor cells were positive for cluster of differentiation 99 (CD99), negative for estrogen receptor (ER), progesterone receptor (PR), and cytokeratin 5/6 (CK5/6). These findings are consistent with those of metastatic osteosarcoma to the breast, rather than primary metaplastic carcinoma of the breast (×100).

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