Metastatic breast cancer

Case contributed by Dr Julian Maingard

Presentation

50 year old female with a past history of breast cancer presents with increasingly painful and swollen right shoulder.

Patient Data

Age: 50
Gender: Female
X-ray

Right Humerus: There is a pathological fracture at the junction of proximal and middle thirds of the humerus secondary to a an extensive destructive bone lesion associated with a large soft tissue mass and irregular periosteal new bone. 

Case Discussion

The above case demonstrates humeral metastases from a breast cancer primary. 

Histology

Macroscopic:
A right forequarter amputation including hand with five digits (140x90x55mm), forearm (240mm length, up to 85mm diameter), upper arm (300mm length and up to 150mm diameter) with scapula
(165x100x35mm). There is a soft tissue margin 160x130mm, inked black.

Within the soft tissue of the upper arm, there is a well demarcated rubbery to firm cream tumour with extensive areas of necrosis and cavitation, 140x110x105mm. There is invasion into, and in areas, complete obliteration of the humerus. Tumour is 4mm from the overlying skin, which shows mild dark brown discolouration. Tumour is 30mm from the soft tissue resection margin and more than 50mm from the bone resection margin.  The remaining skin and soft tissue are unremarkable.

Microscopic: 

Sections show the tumour show poorly differentiated carcinoma composed of sheets and interconnected nests of cells with large hyperchromatic markedly pleomorphic nuclei, moderate amounts of cytoplasm and numerous mitotic figures including abnormal forms, set within desmoplastic stroma.  There is moderate tumour necrosis.  Some areas appear vaguely squamoid.  Tumour involves fibrofatty tissue and skeletal muscle.  Sections of margins are clear of tumour.  The calcified sections are to follow.

Diagnosis:
Metastatic poorly differentiated carcinoma.

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Case information

rID: 31676
Case created: 20th Oct 2014
Last edited: 2nd Dec 2015
Inclusion in quiz mode: Included

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