Primary osteogenic sarcoma of the breast: A case report

Treatment conundrums in osteosarcoma of the breast: Case report of two cases from a tertiary care cancer center in India

Extraosseous sarcoma of the breast is an infrequent entity and a harbinger of poor prognosis. Histogenesis of this tumor is uncertain, and it can arise both in denovo and metastatic settings. Morphologically, it is indistinguishable from its skeletal counterpart and clinically, it presents like any other subtype of breast cancer. Tumor recurrence with a propensity for hematogenous rather than lymphatic spread plagues with this malicious disease. Treatment guidelines are mainly extrapolations from those of treatment of other extra-skeletal sarcomas as literature is limited in this context. In this study, it was aimed to present two clinical cases with similar clinical profiles and different treatment outcomes. The intent of this case report is to contribute to the limited database available for management of this rare disease.

Primary Osteosarcoma of the Breast: A Rare Case Report and Literature Review

Background

Primary osteosarcoma of the breast (POB) is an extremely aggressive and heterogeneous neoplasm that originates from nonepithelial elements of the mammary gland and accounts for fewer than 1% of breast cancers and fewer than 5% of all sarcomas.

Case Presentation

An 83-year-old Chinese woman went to our hospital because of a palpable mass she had had for 8 months in the left breast accompanied by persistent dull pain for 10 days. This mass was initially misdiagnosed as a degenerating fibroadenoma and was graded as probably benign (BI-RADS category 3) by ultrasonography (US) and computed tomography (CT) plain scan and contrast enhancement of chest. Eight months later, it was presumed to be highly malignant and graded as BI-RADS category 4C because of its rapid growth and more calcifications by US and CT. 99mTc-MDP whole-body bone imaging showed that there was a mass-like abnormal radioactive concentration of Tc-99m outside the bone of the left chest. The lumpectomy of the left breast was indicated, and the pathological findings were POB. She succumbed to respiratory failure caused by multiple lung metastases 4 months after the operation.

Conclusion

POB is rare, and US and CT cannot reliably distinguish the causes of calcified breast masses between benign and malignant tumors. It can be diagnosed by pathology when metaplastic carcinoma, malignant phyllodes tumor, or carcinosarcoma containing osteoid and bone is excluded. This case could help clinicians to improve the prognosis and treatment of this disease.

Primary Osteosarcoma of the Breast with Extensive Chondroid Matrix in a Teenager Female Patient: The Paradoxical Diagnosis in Breast Mastopathy

Purpose

Non-epithelial tumors of the breast are extremely rare and have an incidence of less than 1%. The most common non-epithelial breast tumor is the phyllodes tumor (PT), which accounts for 61%. Primary osteosarcomas of the breast contribute up to only 12.5% of all breast sarcomas. In young females, osteosarcomas are extremely rare, especially in those without a previous history of primary bone osteosarcoma. A case of a 16-year old female with primary osteosarcoma of the breast (POB) with extensive chondroid matrix involving the left breast is herein presented.

Case Report

This report describes a 16-year old female with neither a previous history of bone osteosarcoma nor family history of breast cancer who was diagnosed with a primary chondroblastic osteosarcoma of the left breast. The mass was shining, warm, firm, and slightly fixed. The excisional biopsy showed a large tumor measuring 11x9x7 cm which was encapsulated, grayish-white, and nodular.

Conclusion

Primary osteosarcomas of the breast carry a poor prognosis by being triple negative and because of being the rarest tumors, they pose a challenge in managing the patients due to lack of established treatment modalities.

Primary Osteosarcoma of the Breast

Extraskeletal osteosarcomas are extremely rare and account for < 1% of the soft tissue sarcomas. Most common site is in soft tissues of the lower extremities. Primary osteosarcomas of the breast are extremely rare and only a few cases have been reported in literature. It carries a very dismal prognosis in view of its high rate of local recurrence and distant spread. We report a case of primary osteosarcoma of the breast. A 44-year-old female presented with a 14 × 10 cm solid mass in right breast. She underwent wide excision and frozen section was consistent with metaplastic carcinoma. A possibility of malignant phyllodes tumor was kept therefore right axillary dissection was also done along with. Final histopathology was consistent with high-grade osteogenic sarcoma in view of haphazardly arranged spindle to stellate cells with presence of giant cells and a matrix showing osteoid and cartilaginous differentiation and on IHC tumor cells were positive for Vimentin, EMA, Pankeratin, and P 63 and negative for ER, PR, Her 2 neu, CK 7, CK 8/18, and CK 34. It is imperative to recognize this rare pathologic tumor variant in view of its need of multimodal management and overall poor prognosis. Immunohistochemistry plays an important part in establishing the diagnosis and hence the further management.

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.

Primary breast osteosarcoma: A diagnostic challenge

Extraskeletal osteosarcomas account for < 1% of the soft tissue sarcomas and are known to more often localize in soft tissues of the lower extremities. Primary osteosarcomas of the breast are extremely rare. A majority of the reported cases were in fact initially erroneously diagnosed and treated as primary breast carcinomas. We recently got to treat an interesting case of a primary breast osteosarcoma and discuss its evaluation and management with added emphasis on the incremental role of technetium 99-methylene diphosphonate (Tc-99m) bone scintigraphy in its clinical diagnosis. Tc-99m uptake can occasionally be seen in the delayed bone scintigraphy images of extra skeletal malignancies, but the uptakes are considered to be typically less intense than the uptakes noted in primary skeletal malignancies. Extraskeletal osteosarcomas are however the exceptions to this rule, the intense uptake in bone scintigraphy further aided in an accurate preoperative diagnosis and management of our patient.

Primary breast osteosarcoma: a case report and review of literature

BACKGROUND

Primary soft tissue sarcomas are uncommon. We report a case of primary breast osteosarcoma which was treated successfully. This case report is combined with a literature review of this rare breast malignancy.

METHODS

Electronic literature search of databases: Pubmed/Medline, Ovid and EMBASE, in addition to the search engines Google/Google Scholar and Bing. The keywords used were breast osteosarcoma, soft tissue sarcoma and breast cancer. Searches were screened and those studies thought to be relevant had full text versions retrieved. The references to all retrieved texts were searched for further relevant studies.

CONCLUSION

Primary breast osteosarcoma is a rare breast malignancy that affects elderly patients. Diagnosis is often challenging and can be debatable due to its rarity, non-specific radiological findings and the complicated histopathological subtypes. Surgery is the treatment of choice.

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 the breast: a case report

Introduction. Primary osteosarcoma of the breast is a rare soft-tissue form of osteosarcoma without involvement of the skeletal system. Due to the rarity of the disease, its clinical features and optimal treatment remain unclear. Case Presentation. This case report deals with a 62-year-old woman with pure osteosarcoma of the breast. Conclusions. The prognosis of primary osteosarcoma of the breast is poor. Recurrence is frequent, and it is often associated with haematogenous spread of the disease to the lung. Treatment follows the model of sarcomas affecting other locations and must be planned in a multidisciplinary fashion. Adjuvant chemotherapy should be considered for patients with tumors showing aggressive features.

Unilateral synchronous breast tumors. Rare association of myofibroblastoma and osteosarcoma

The authors describe the case of a patient with two particularly rare contiguous tumors, myofibroblastoma and osteosarcoma, in the same breast. Rare does not mean untreatable, and the chance of recovery is no less than with more common tumors. However, rare tumors do present a significant problem for pathologists due to diagnostic difficulties, and so an exact prognosis is not always possible.

Primary osteosarcoma of breast

Primary osteosarcoma of breast is rare. The authors present a case of a 51-year-old female who was admitted with a large necrotising tumour involving the right breast. CT scan confirmed chest wall invasion along with a solitary lung metastasis. She underwent a primary mastectomy with chest wall reconstruction. Unfortunately 3 months later she developed local recurrence.

Primary osteosarcoma of the breast- a case report and review of literature

Primary Osteosarcoma of the breast is an aggressive and relatively rare tumour whose prognosis is very poor.It is often a diagnostic dilemma to the pathologists and the surgeons are perplexed due to its aggressive behaviour as its pathology and prognostic factors are unclear. Due to its rarity we suggest pooling of tissue samples from various centres in biobanks for future studies (including molecular biological studies) so that its behaviour can be better understood.

Breast sarcomas: current and future perspectives

Breast sarcomas are rare neoplasms of the breast that need to be clearly distinguished from the very common breast carcinomas and treated in a multidisciplinary manner modelled after treatment paradigms in other sarcoma locations. An increasing need to differentiate sarcoma sub-types based on molecular characteristics that will also be depicted in differential treatment sensitivities and development of specifically targeted therapies are equally valid in sarcomas in general and in breast sarcomas in particular. Of special interest in breast are sarcomas developing after breast irradiation for a previous breast carcinoma, a scenario that is increasingly common, given the increasing trends of breast conservation in the surgical treatment of breast carcinoma that necessitates the adjuvant use of radiotherapy.