Primary osteosarcoma of the breast

Primary breast osteosarcoma: A case report and review of the literature

Primary breast osteosarcoma (PBOS) is an extremely rare and poor prognostic malignancy that has not a definitive treatment guideline. Here, we presented a successfully treated case of PBOS and provided a comprehensive review of the literature which revealed the divergence of opinions regarding the histogenesis and management of this malignancy.

Primary Osteosarcoma of the Breast: Pathophysiology and Imaging Review

Extraskeletal osteosarcoma are rare malignant mesenchymal neoplasms of soft tissues representing around 1% of all soft tissue. The exact mechanism of tumorigenesis of primary breast osteosarcoma is still unclear. However, most of the cases develop without a recognized etiologic factor. Primary osteosarcoma of the breast is often initially misdiagnosed as breast fibroadenoma. Different imaging modalities and pathology play important role in differentiating breast osteosarcoma from other benign and malignant lesions of the breast resulting in dramatic change in the management.

Phyllodes Tumor with Osteosarcomatous Differentiation: A Comparative Immunohistochemical Study between Epithelial and Mesenchymal Cells

Aims and background

Phyllodes tumor of the breast with osteosarcomatous differentiation is rare and very little is known about its molecular profile.

Methods and study design

An immunohistochemical panel with 37 primary antibodies including cytokeratins, mesenchymal markers, key regulators of the cell cycle, oncogenes, apoptosis-related proteins, metalloproteinases and their inhibitors was performed on a formalin-fixed paraffin-embedded sample of phyllodes tumor with osteosarcomatous differentiation in a 49-year-old woman.

Results

Antiapoptotic stimuli (survivin) predominated in sarcomatous cells. Antiproteolytic stimuli (TIMP-1, TIMP-2 and PAI) were preponderant in all cells, a surprising fact in view of the aggressiveness of the neoplasm. The immunoprofile of the osteoblastic and stromal cells was quite similar, except for c-erbB-3, c-myc, cyclin D1 and p21. Both exhibited positive cells for actin, MyoD1 and GFAP.

Conclusions

Our results suggest that this osteosarcoma may have originated from metaplasia of stromal cells that underwent a malignant change.

Primary osteosarcoma of the breast: a case report

Primary osteosarcomas of the breast are extremely uncommon. Here we describe a case of a 77-year-old woman who presented with a hard mass on her right breast. Mammography and breast ultrasound demonstrated a round-shaped calcified mass on the right breast but the features were not definitely diagnostic. For diagnostic purposes, an excisional biopsy was performed and the mass proved to be a primary osteosarcoma of the breast by pathologic findings. PET-CT and whole body bone scan showed neither evidence of metastasis nor underlying bone lesions. Wide excision without axillary lymph node dissection was performed after diagnosis. Further treatment such as adjuvant chemotherapy or radiation therapy was not performed. We discuss proper treatment of this rare type of breast cancer.

Primary Osteosarcoma of the Breast Arising in an Intraductal Papilloma

INTRODUCTION

Primary osteosarcoma of the breast is extremely rare, and an osteosarcoma arising from an intraductal papilloma is exceptional.

CASE PRESENTATION

A 72-year-old Saudi Arabian woman presented with a solid, bone-containing breast mass that was diagnosed as primary osteosarcoma of the breast on biopsy. She had a history of untreated intraductal papilloma. Treatment was completed with a modified mastectomy after excluding extramammary metastases. However, she subsequently developed multiple recurrent lesions at the same site.

CONCLUSION

Primary osteogenic sarcomas of the breast are very rare. Although the main treatment is resection the optimal management remains uncertain and prognosis is poor.

Primary osteosarcoma of the breast after complete resection of a metaplastic ossification: a case report

BACKGROUND

Primary osteosarcoma of the breast is an extremely rare lesion. The pathogenesis of primary osteosarcomas is controversial.

CASE PRESENTATION

We present the case of a 63-year-old white German woman who presented with a mass in her right breast after routine screening. The core needle biopsy showed ductal hyperplasia with metaplastic ossification of the breast tissue. Complete excision of the lesion with standard safety margins was performed. The final diagnosis was metaplastic ossification. Three years later, our patient presented again with a painless lump in her right breast about 15 × 8 × 7 cm, extending to the lower part of axilla with skin ulceration. Pathologic diagnosis was osteosarcoma. Positron emission tomography and computed tomography and staging showed no other lesions. Modified radical mastectomy and axillary lymph node dissection was performed, no lymph node metastases were found.

CONCLUSIONS

Our case highlights the possibility that primary osteosarcoma of the breast may develop after complete resection with the classical safety margin for metaplastic ossification. Long-term follow-up after resection of this benign breast lesion is required.

Primary osteosarcoma of the breast: pathological and imaging findings

Primary osteosarcoma of the breast (POB) is an extremely rare and aggressive tumor. Differential diagnosis of POB includes osteosarcoma of the chest wall and metaplastic breast carcinoma. Imaging tests that exclude the existence of a direct connection between the tumor and chest wall, as well as histopathological and immunohistochemical studies that rule out the presence of an epithelial component are required for the diagnosis of POB. We report a case of a 69-year old woman with POB. Imaging and pathological findings are presented. Therapeutic approach is discussed in the light of current knowledge, including potential complications.

Primary osteosarcoma of the breast: a case report

We report a rare case of primary osteosarcoma of the breast in a patient who presented a calcified fibroadenoma one year before the appearance of the malignant lesion. We describe the follow-up of the patient and the discovery of a similar osteosarcoma in the other breast one year later.

Evolution and prognosis of breast osteosarcoma: A case report

Breast osteosarcoma is a rare malignancy of unknown etiology, with no standard adjuvant treatment at present. The prognosis of the disease is poor, and it has a high propensity for recurrence and metastasis. The current report presents the case of a 52-year-old woman, in whom adenomyoepithelioma gradually developed into breast osteosarcoma following three separate surgeries. The patient survived for 41 months from the initial lesion occurrence and resection in the left breast; during this time, she underwent surgery and chemotherapy (liposomal doxorubicin and cisplatin) for the treatment of disease recurrence and lung metastasis, along with molecular-targeted therapy (sunitinib). However, the patient eventually succumbed to respiratory failure due to progressive disease. The present case underwent a clear pathological transformation process, and may provide a basis for an improved understanding of the clinical characteristics and treatment of breast osteosarcoma.

Primary osteosarcoma of the breast: A case report

Osteosarcoma (OS) located in the breast is an extremely rare, malignant neoplasm. The current study presents the diagnostic process, treatment and follow-up of a 67-year-old female with OS of the breast. The diagnosis was made according to diagnostic imaging methods and microscopic examination with additional immunohistochemical staining. As a surgical treatment, tumourectomy with intraoperative histological examination and simple breast amputation was performed. No adjuvant chemotherapy was administered following surgery. Lung and bone metastases occurred without local recurrence 14 months following the surgery. In the present study, the details of the diagnostic examinations performed are evaluated and the consecutive phases of diagnostic and therapeutic proceedings are examined in comparison with the knowledge in the literature.

Primary osteosarcoma of breast, a rare case

Mammary sarcomas are very uncommon and make up less than 1% of all primary breast malignancies.Primary osteosarcoma of the breast is extremely rare and represents 12.5% of mammary sarcomas. A secondary lesion from a primary osteosarcoma of the bone should be considered in the differential diagnosis. In addition, the absence of a direct connection between the tumour and the underlying skeleton is mandatory for the diagnosis.We report a case of primary osteosarcoma of the breast occurring in young patient with fatal evolution.

Primary osteosarcoma of the breast: case report

Mammary sarcomas are very uncommon and make up less than 1% of all primary breast malignancies.Primary osteosarcoma of the breast is extremely rare and represents 12.5% of mammary sarcomas. A secondary lesion from a primary osteosarcoma of the bone should be considered in the differential diagnosis. In addition, the absence of a direct connection between the tumour and the underlying skeleton is mandatory for the diagnosis.We report a case of primary osteosarcoma of the breast occurring in young patient with fatal evolution.

Primary Osteosarcoma of the Breast: Report of 2 Cases

Two distinct histologic variants of primary breast osteosarcoma in 2 elderly women are described. The first patient was an 88-year-old woman with a long-standing, slow-growing, 18-cm mass in her right breast. The second patient was a 96-year-old woman with a recently self-detected, painless, 7.5-cm lump in her left breast. Clinically, there was no evidence of metastasis, and both women underwent simple mastectomy. Histologic features of both specimens were those of high-grade primary breast osteosarcoma. The first patient's tumor was classified as a chondroblastic variant, and the second as an osteoblastic variant of osteosarcoma. The patients were alive without evidence of local recurrence or hematogenous spread at a 16- and 4-month follow-up, respectively. Primary mammary osteosarcoma should be distinguished from metaplastic/ sarcomatoid carcinoma with heterologous osseous/cartilaginous differentiation or malignant phyllodes tumor because it has a different biological behavior and requires a different treatment approach.

Primary osteogenic sarcoma of the breast

BACKGROUND

Primary extra-osseous osteogenic sarcomas have been reported in many tissues of the body but their occurrence in the breast is extremely rare. It can arise as a result of osseous metaplasia in a pre-existing benign or malignant neoplasm of the breast or as non-phylloides sarcoma from the soft tissue of a previously normal breast.

CASE PRESENTATION

A 40 year-old Nigerian woman was clinically diagnosed to have carcinoma of the left breast. The histology report of core-needle biopsy of the mass showed a malignant neoplasm comprising islands of chondroblastic and osteoblastic stromal cells. This report changed the diagnosis from carcinoma to osteogenic sarcoma of the breast. She had a left modified radical mastectomy, however there was significant post surgery skin deficit. A latissimus dorsi musculocutaneous flap was used to cover the anterior chest wall defect. Sections from the mastectomy specimen confirmed the diagnosis of osteogenic sarcoma. She died six months after mastectomy.

CONCLUSION

A diagnosis of osteogenic sarcoma of the breast was made based on histology report and after excluding an osteogenic sarcoma arising from underlying ribs and sternum. This is the second documented case of primary osteogenic sarcoma of the breast coming from Nigeria.

Osteosarcoma arising in the breast

We report on a 49-year-old woman with osteosarcoma arising in the breast. She had undergone two consecutive excision biopsies for right breast tumors at ages 40 and 42 years. The tumors were diagnosed as a fibroadenoma and a benign phyllodes tumor, respectively. At age 46 years, she noticed a gradually enlarging mass in the same breast. After 3 years, at age 49 years, total mastectomy was performed. The tumor occupied the entire breast and measured 12x9x8.5 cm. The tumor cells were spindle-shaped and pleomorphic, with large, irregular nuclei and distinct nucleoli. Many tumor cells had characteristics of osteoblastic and chondroblastic elements producing osteoid, osseous, and cartilaginous intracellular substances. Pathologic mitoses and apoptotic cells were frequent. Neoplastic cells had infiltrated the skin. Blood and lymph vessel invasion was present. Tumor cells expressed vimentin, osteopontin, vascular endothelial growth factor, CD10, and alkaline phosphatase, but did not express keratin. Chemotherapy was not effective. The patient died of multiple pulmonary metastases 9 months after mastectomy.

[Syntopical and synchronous leiomyosarcoma and papillary carcinoma of the female breast]

A 61 years old female was treated by total lumpectomy due to a palpable and radiologically demonstrable tumor measuring 22 cm in diameter in the left breast. Two different but directly neighboured malignant tumours were found: a poorly differentiated leiomyosarcoma and a well differentiated invasive papillary carcinoma of the breast. The latter had metastasized in 4 axillary lymph nodes. Three months after surgery the patient died. Post-mortem studies showed many metastases of the leiomyosarcoma in both lungs, the heart, the liver, the left kidney and both adrenals. Cause of death were relapsing pulmonary thrombembolisms. Case reports of leiomyosarcomas following radiotherapy of the breast cancer are published but coincidental occurrence of both metastasizing tumors are so far not known from the literature.

Primary osteogenic sarcoma of the breast: a clinicopathologic analysis of 50 cases

Extraskeletal osteosarcomas are rare. Few primary mammary osteosarcomas have been reported; many of these have been described in association with a biphasic tumor. Fifty pure osteosarcomas of the breast, diagnosed between 1957 and 1995, were reviewed after excluding those of biphasic origin. The absence of epithelial differentiation was confirmed using a panel of immunohistochemical markers in 32 cases and using ultrastructural evaluation in an additional four cases. Tumors occurred in 49 women and one man; age ranged from 27 to 89 years (median, 64.5 years). One patient received radiotherapy for ipsilateral breast carcinoma 9 years before presentation. Patients were treated by excisional biopsy (n = 13), tylectomy (n = 5) or mastectomy (n = 32). All axillary nodes, dissected in 20 patients, were free of tumor. One patient had extramammary spread at diagnosis. The neoplasms were 1.4 cm to 13.0 cm (mean, 4.6 cm), and 60% were grossly circumscribed. Tumors were classified as fibroblastic (n = 28), osteoclastic (n = 14), or osteoblastic (n = 8). Of 39 patients with available follow-up information, locally recurrent (n = 11) and metastatic (n = 15) disease developed in 23 (59%) at a mean of 10.5 and 14.5 months from diagnosis. Eight (73%) patients in whom local recurrence developed were treated with excisional biopsy or tylectomy; of these, seven had a positive margin. Sixteen (41%) patients died of disease at a mean of 17.1 months, within 20 months of onset of metastases, most commonly to the lung. Mammary osteosarcomas are aggressive tumors with a propensity for blood-borne rather than lymphatic spread. Total excision without axillary dissection is advised.

Malignant adenomyoepithelioma of the breast with mixed osteogenic, spindle cell, and carcinomatous differentiation

A 50-year-old woman had a malignant tumor of the left breast, which recurred twice, metastasized, and caused death after 39 months. Histologically, the original neoplasm and the first recurrence comprised an adenomyoepithelioma, in addition to a sarcoma composed of trabeculae of mature and immature bone, osteoid, and partly calcified, dense collagenous tissue. The trabeculae were lined by alpha-smooth muscle actin-positive mononuclear tumor cells, which also extended into the stroma. Similarly, scattered osteoclastlike, multinucleate giant cells were present in the stroma and in the region of the trabeculae. This same pattern of adenomyoepithelioma and osteosarcoma also was seen in the last recurrence, together with a proliferation of undifferentiated malignant spindle-shaped cells. The last biopsy also contained a separate small focus of invasive ductal carcinoma of usual type. It was concluded that this, apparently unique, tumor probably represented an adenomyoepithelioma in which a metaplastic sarcoma of osteogenic and undifferentiated types developed from the myoepithelial element, and in which a carcinoma developed from the epithelial component.