Metastases of a Myxoid Chondrosarcoma to the Breast

Introduction

Breast cancer is the leading cause of death from cancer in women. The metastatic involvement of the breast is a relatively rare condition. Metastatic disease of the breast is therefore often an unexpected diagnosis in a female patient presenting with a breast mass and usually predicts poor survival. The most common cause for intramammary metastases is spread from a contralateral breast carcinoma. Common solid, extramammary cancers metastasizing to the breast are, in declining order of frequency, malignant melanoma, lymphoma, lung cancer, ovarian carcinoma, soft tissue sarcoma as well as gastrointestinal and genitourinary tumors. Intramammary metastases usually present as round masses with well circumscribed or ill-defined borders. Metastatic lesions are much more likely to be multiple and bilateral than primary cancers but may mimic benign disease in imaging modalities (Birke S et al. Fortschr Röntgenstr 2006; 178: 919 – 921; Kelkar PS et al. Eur J Radiol 1997; 24: 159 – 162). Especially in women with known malignant disease correlation between the histology of the primary and the breast tumor is mandatory to avoid surgical breast biopsy or unnecessary mastectomy and to implement an appropriate systemic treatment (Akcay MN. Breast 2002; 11: 526 – 528). Primary sarcomas of the breast represent less than 1 % of all mammary malignancies. Most studies about breast sarcomas describe a variety of lesions that mainly include cystosarcoma phyllodes (Tavassoli F. Pathology of the Breast, 2nd edn. 1999 Appleton and Lange). Few cases of the extremely rare primary osteosarcomas, angiosarcomas or fibrosarcomas are published in literature (Adem C et al. Br J Cancer 2004; 91: 237 – 241). Only few cases of metastases of soft tissue sarcoma to the breast are described, e. g. metastases of rhabdomyosarcomas (Sheen-Chen SM et al. Anticancer Res 2005; 25: 527 – 529) or Ewing sarcomas (Astudillo L et al. Am J Clin Oncol 2005; 28: 102 – 103). To our knowledge no radiologic features of chondrosarcoma metastases to the breast have already been reported.

The ultrasonographic, mammographic and MR-tomographic appearance of metastases of a myxoid chondrosarcoma in the left breast is exemplified on the basis of the present case.