Presentation
Several years of pain in the right hip joint.
Patient Data
Extensive predominantly sclerotic and expansile lesion affecting the entire right hemipelvis. No bony lesions elsewhere.
No visible fracture or other acute bony abnormality.
Extensive predominantly sclerotic abnormality of the right hemipelvis, with bony expansion. There are several lytic components, such as in the right ilium adjacent to the right sacro-iliac joint.
Pathology
Microscopy
Histological sections of this bone biopsy show extensive infiltration of the marrow by a tumor with a trabeculated, focally microacinar morphology.
Immunohistochemistry shows positive staining for CK7, ER and GATA3. There is focal positivity for CEA. There is no staining for CK20, CDX2, TTF-1, WT1, CA125, PAX8.
Summary:
The appearances are those of a metastatic carcinoma with an immunophenotype consistent with spread from the previous breast carcinoma diagnosed in 2003.
Case Discussion
This was a patient with previous breast cancer and is an interesting case with an unusual pattern of bony disease. Biopsy confirmed this to be metastatic breast cancer. The initial X-ray appearance resembles Paget disease, with sclerosis and bony expansion and coarse trabeculae. The fact that the abnormality is completely unilateral within the pelvis may also suggest Paget disease. The lytic components are not readily identifiable on the initial plain film.
The only other site of bony involvement in this patient is a small metastasis in the T12 vertebra (imaging not included here).
It is always important to consider the possibility of metastatic breast cancer in patients with sclerotic bony abnormalities (even if the pattern of abnormality perhaps suggests another diagnosis!). The history of breast cancer was not included in the patient presentation here but this is often the case in real life (particularly if there has been several years since original diagnosis)!