Journal of Orthopedic Oncology
Open Access

Bone metastasis; Tomography; Breast cancer

Introduction

For incidental findings, this patient underwent excessive follow-up imaging and an unnecessary bone biopsy. This case study and others in the literature show that mimickers of bone cancer metastasis can cause unnecessary biopsies, inappropriate or delayed treatment, and patient anxiety. Disorders of the sclerosing bone, characterized by discrete or generalized increases in bone mass, may resemble bone metastasis [1]. Discusses the radiographic characteristics of potential mimics of sclerosing bone disease. Sclerosing bone dysplasias are a distinct group of skeletal abnormalities characterized by a diverse set of radiologic, clinical, and genetic features. The bone ossification pathway is disrupted in some way by each disorder, and some of the disorders share genetic pathways with one another, possibly representing phenotypic variants of the same disease [2]. In almost all cases, the Tc-99 m bone scan can distinguish metastases from osteopetrosis and sclerotic dysplasia, as the patient described in the report did. A Tc-99 m bone scan is usually sufficient to avoid the need for an FDG PET scan, which has a high sensitivity for distinguishing between benign and malignant bone involvement. A 57-year-old woman with breast cancer and biopsyconfirmed metastasis to the lumbar spine was described in a 1992 case series.

Results

Back pain got worse after chemoradiation therapy was done. Both a CT scan and an X-ray of the spine revealed osteoblastic lesions at L4 and L5. She had a fever two weeks later, and a vertebral biopsy revealed vertebral osteomyelitis that was treated with intravenous antibiotics. On bone scintigraphy and 67Ga bone scanning, another patient had osteomyelitis that was mistaken for metastatic disease [3]. However, an In-labeled WBC scan later revealed that the patient had an infection. In such patients with infection, it may be necessary to delay starting antibiotics. In another instance, a 54-year-old woman with a history of breast cancer underwent a PET-CT scan for an elevated CA 27.29. The scan revealed a sclerotic lesion in the right sacrala, which, upon biopsy, revealed brown fat cells (Dannheim and Bhargava, 2016) [4]. Another breast cancer patient had a bone scan that showed nothing, but X-ray and CT scans showed multiple sclerotic nodules all over the skeleton, which eventually led to the diagnosis of osteopoikilosis. Osteopoikilosis frequently manifests itself on imaging as “spotted bones,” typically consisting of numerous small round or oval lesions that persist for decades and are typically asymptomatic. In this instance, biopsies, imaging, and patient anxiety were reduced thanks to early recognition. In another case, bone scintigraphy revealed an increased osteoblastic activity indicative of rib infiltration in a 33-year-old woman with a left breast mass contacting the ribs. Myositis ossificans was found in the rib resection and tumor pathology without evidence of metastatic disease [5].

Discussion

The treatment of this patient involved a lot of surgical excision. On Dual-energy X-ray Absorptiometry, a patient with a history of breast cancer showed increased lumbar spine bone mineral density, and on CT, multiple sclerotic foci in the spine indicated metastatic bone disease [6-8]. The next year, the lesions were seen on an MRI, but there was no uptake on a Tc-99 m bone scan. Systemic mastocytosis, a generalized disorder characterized by bone marrow infiltrates that leads to osteoporosis, was discovered after further review of her medical record. As a result, patients had to endure years of repeat imaging and felt more anxious [9]. One more lady with a background marked by bosom disease had osteolytic injuries on imaging and later a bone biopsy was subsequently determined to have essential hyperparathyroidism furthermore, the sores which were osteitis fibrosa cystica self-settled after a parathyroid resection [10].

Conclusion

When reviewing imaging reports, it is important to keep in mind the patient’s background medical and imaging history as well as a broad differential, even though bone metastases are common in breast cancer patients. In two of the three instances in which this patient underwent imaging, the lack of background information likely influenced management decisions. It is helpful to provide the radiologist with this background prior to the protocoling of the study, particularly for directing the subsequent steps. With this said, there is huge cross-over in clinical imaging discoveries and imaging doesn’t completely trade the requirement for pathologic finding on the off chance that there stays a concern for metastatic infection in light of clinical judgment. In the future, avoiding unnecessary management steps may be made easier by being aware of OPT’s role as a mimic of bone metastasis.

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