J Breast Cancer.  2014 Mar;17(1):83-87.

Polyostotic Fibrous Dysplasia Mimicking Multiple Bone Metastases in a Patient with Ductal Carcinoma In Situ

• Lee JH
• Kim SY
• Lee JE
• Cho EY
• Choi YL
• Choi JY
• Han SW
• Kim SW
• Kil WH
• Nam SJ

Abstract

Whole-body bone scans and whole body 18F-fluorodeoxyglucose positron emission tomographic/computed tomographic scans are sensitive for detecting bone metastasis in patients with breast cancer. However, it is often difficult to discriminate between bone metastasis and other nonmalignant bone lesions. Polyostotic fibrous dysplasia is a rare disorder characterized by the osteoid medullary cavity filling with fibrous tissue causing bony expansion. We report the case of a 42-year-old female patient with ductal carcinoma in situ, which appeared to have multiple bone metastases on initial work-up images. Subsequently, the bone metastases were identified as polyostotic fibrous dysplasia. The patient underwent modified radical mastectomy and subsequently visited for a second opinion regarding the bony metastases. She underwent right ilium computed tomography-guided biopsy. Pathology was consistent with fibrous dysplasia. This patient received only adjuvant tamoxifen, and 1.5 years later, there was no evidence of recurrence.

Keyword

Breast neoplasms; Fibrous dysplasia of bone; Neoplasm metastasis; Positron-emission tomography; Whole body imaging

MeSH Terms

Adult
Biopsy
Breast Neoplasms
Carcinoma, Ductal*
Carcinoma, Intraductal, Noninfiltrating*
Electrons
Female
Fibrous Dysplasia of Bone
Fibrous Dysplasia, Polyostotic*
Humans
Ilium
Mastectomy, Modified Radical
Neoplasm Metastasis*
Pathology
Positron-Emission Tomography
Recurrence
Referral and Consultation
Tamoxifen
Whole Body Imaging
Tamoxifen

Figure

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  Figure 1 The chest X-ray as a baseline study for general anesthesia. Osteolytic lesions of the right second, third, eighth, and left fourth ribs, which is suggestive of multiple bone metastases.

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  Figure 2 The baseline whole body bone scan. Abnormal increased uptake was demonstrated in the right parietal, occipital, cervical, thoracic, lumbar, sacral spine, bilateral scapulae, multiple ribs, bilateral pelvic bones, right femur, tibia, fibula, right tarsal bone, sternum, and right humerus.

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  Figure 3 Microscopic examination of breast tumor. Cribriform-tumor clusters, with architectural and nuclear atypia, consistent with ductal carcinoma in situ (A, H&E stain, ×40; B, H&E stain, ×200).

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  Figure 4 Microscopic examination of biopsied specimen of the right ilium. Photomicrograph was demonstrated irregularly shaped islands of woven bone with a bland spindle cell background stroma (H&E stain, ×200).

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  Figure 5 Follow-up bone scan after 1 year. Increased radio-uptake in the skull, right second, third, fourth, sixth, eighth, and left fourth ribs, right ilium, right ischium, right acetabulum, right femur, right tibia, right fibula, and second phalanx of right foot, which is suggestive of polyostotic fibrous dysplasia, but which cannot exclude combined metastasis.

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  Figure 6 Follow-up 18F-fluorodeoxyglucose (FDG) positron emission tomographic/computed tomographic scan after 1.5 years. Increased FDG uptake in the right first, second, third, eighth, and left fourth ribs, right femur, right ischium, and right ilium, which is suggestive of polyostotic fibrous dysplasia, but which cannot exclude multiple metastases.

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