Vertebral metastases (breast carcinoma)

Case contributed by Dr Bruno Di Muzio

Presentation

Previous history of breast cancer.

Patient Data

Age: 45 years

Thoracic and lumbar spine CT

CT

Diffusely sclerotic bones with no evidence of associated pathologic fractures or significant spinal canal or intervertebral foramina stenosis. 

Bone scans (one year apart from each other)

Nuclear medicine

Tc99m diphosphonate bone scan images one year apart from each other demonstrate the diffuse progression of the bone metastasis uptake. 

Case Discussion

This patient had a bone biopsy at the time of the first sclerotic lesion presentation, as it would be crucial for treatment options at that time. 

MICROSCOPIC DESCRIPTION: Sections show multiple fragments of bone. There is focal fibrous tissue and some degenerate cells within this fibrous tissue. No definite evidence of malignancy is seen.

DIAGNOSIS: Bone biopsy:  Occasional degenerate cells positive with Cam5.2and AE1/AE3. Features suspicious for a metastatic carcinoma. There is minimal diagnostic material available for examination. The degenerate cells show strong staining with estrogen receptor and negative for progesterone receptor. HER 2 score 0. There is limited diagnostic material, but the features are supportive of ER+ metastatic adenocarcinoma of the breast.

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