J Breast Cancer.  2010 Dec;13(4):448-451. 10.4048/jbc.2010.13.4.448.

Painless Posterior Thigh Mass as a Presentation of Metastatic Breast Cancer

• Cho HM
• Ko MS
• Lee JH
• Jung WS
• Choi HJ
• Oh SJ
• Suh YJ

• KMID: 2286535
• DOI: http://doi.org/10.4048/jbc.2010.13.4.448

Abstract

Soft tissue metastasis clinically presenting as either painless subcutaneous or painful intramuscular nodules is extremely rare and may lead to an errant clinical suspicion of sarcoma. In general, most soft tissue metastasis comes from lung carcinoma; however, to date, there have been no reports of a posterior thigh mass just beneath the skin metastasizing from breast cancer. Here, we report a case of distant soft tissue metastasis presenting as a painless solitary left posterior thigh mass measuring 1.5 cm in diameter, which was later shown by positron emission tomography-computed tomography (PET-CT) to have multiple simultaneous mediastinal lymph node metastases. Eleven months ago, the patient had undergone curative breast-conserving surgery (BCS) for cancer of her left breast. At that time, her tumor showed a triple negative phenotype. Initial PET-CT right before the BCS had shown no metastasis. After histological and radiologic evaluation for the metastases, she decided to have systemic chemotherapy.

Keyword

Breast neoplasms; Metastasis; Thigh

MeSH Terms

Breast
Breast Neoplasms
Electrons
Humans
Lung
Lymph Nodes
Mastectomy, Segmental
Neoplasm Metastasis
Phenotype
Sarcoma
Skin
Thigh

Figure

• 

  Figure 1 (A) Positron emission tomography-computed tomography (PET-CT) scan taken right after a curative breast cancer operation. Postoperative PET-CT showed no distant dissemination from the primary left breast cancer. (B) PET-CT scan at follow-up. PET-CT scan taken eleven months after the curative operation showed several mediastinal lymph nodes and possible pleural nodules along with a left thigh mass, which were suggestive of distant metastasis from the primary breast cancer.

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  Figure 2 (A) Metastatic nodule at the left posterior thigh. Undifferentiated carcinoma cells are seen blending with the matrix material. The lacunar structure of cartilage is not present. (H&E stain, ×200). (B) Index tumor. Grade III invasive ductal carcinoma from the left upper breast with ductal carcinoma in situ (comedo type) (H&E stain, ×100). (C) Immunohistochemical staining (IHC) of human epidermal growth factor receptor in the metastatic nodule. The result of IHC was ++, which was later proven negative by fluorescence in situ hybridization (×200).

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