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Breast Metastasis of Extraskeletal Myxoid Chondrosarcoma: A Case Report.

Lubana SS, Bashir T, Tuli SS, Kemeny MM, Heimann DM - Am J Case Rep (2015)

Bottom Line: The mass was fully resected with left below-knee amputation.A follow-up CT showed a new right breast nodule along with metastases to lung and bones.The results of the core needle biopsies of the right breast masses seen on mammogram were morphologically identical to extraskeletal myxoid chondrosarcoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.

ABSTRACT

Background: Extraskeletal myxoid chondrosarcoma is a unique and distinct clinicopathological entity in terms of its origin, morphology, and biologic behavior. Despite being a slow-growing tumor, it has a high rate of local recurrences and history of metastases to uncommon sites like the mandible, liver, retroperitoneum, right ventricle, pancreas, and central nervous system. Here, we report a very unique case of extraskeletal myxoid chondrosarcoma that metastasized to the breast, which itself is a very rare site for metastases.

Case report: A 58-year-old woman presented with a large, firm, and tender soft-tissue mass (6.0×7.0 cm) underneath the sole of the left foot. A computerized tomography (CT) scan showed a heterogeneous lobulated mass in the plantar aspect of the forefoot, measuring 8.6×8.0×7.1 cm. Punch biopsies revealed histology consistent with extraskeletal myxoid chondrosarcoma. Metastatic work-up was negative. The mass was fully resected with left below-knee amputation. The histology of the resected mass was consistent with extraskeletal myxoid chondrosarcoma. A follow-up CT showed a new right breast nodule along with metastases to lung and bones. The results of the core needle biopsies of the right breast masses seen on mammogram were morphologically identical to extraskeletal myxoid chondrosarcoma.

Conclusions: Although rare, metastases to the breast should be considered in the differential diagnosis of a breast mass. A close long-term follow-up is needed due to the unpredictable behavior of extraskeletal myxoid chondrosarcoma and the high frequency of local recurrences, metastases, and death due to disease.

No MeSH data available.


Related in: MedlinePlus

Histopathology of surgical specimen revealing. (A) A multinodular architecture and well circumscribed masses with internal fibrous septa. (B) An abundant myxoid matrix containing round or slightly elongated cells with small hyperchromatic nuclei.
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f5-amjcaserep-16-406: Histopathology of surgical specimen revealing. (A) A multinodular architecture and well circumscribed masses with internal fibrous septa. (B) An abundant myxoid matrix containing round or slightly elongated cells with small hyperchromatic nuclei.

Mentions: Metastatic work-up was negative and the patient underwent left below knee amputation while awaiting the results of molecular testing. The amputation was planned because the location of the mass would have precluded skin closure. The mass was fully resected with negative margins. The resected tumor was tan-gray and bulging, measuring 9.0×7.0×5.5 cm. The cut surface of the tumor was tan-red and mucinous in appearance, with areas of hemorrhages. The tumor extended to the inter-digital area of the second and third toe and involved the articular surfaces of the distal metatarsal heads of the second and third toes. The skin, bone, and soft-tissue margins were grossly viable. The resected margins were negative. As per World Health Organization classification of the soft-tissue tumors, the tumor was identified as EMC (Figure 5). Mitotic rate was 5/10 high-power fields (HPF) and necrosis was present (extent 50%). Histologic grade as per French Federation of Cancer Centers Sarcoma Group (FNCLCC) was Grade 2. Pathologic staging was pT2bNX. The results of molecular testing were positive for rearrangement of EWSR1 gene at 22q12, thus confirming the diagnosis of EMC.


Breast Metastasis of Extraskeletal Myxoid Chondrosarcoma: A Case Report.

Lubana SS, Bashir T, Tuli SS, Kemeny MM, Heimann DM - Am J Case Rep (2015)

Histopathology of surgical specimen revealing. (A) A multinodular architecture and well circumscribed masses with internal fibrous septa. (B) An abundant myxoid matrix containing round or slightly elongated cells with small hyperchromatic nuclei.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4492482&req=5

f5-amjcaserep-16-406: Histopathology of surgical specimen revealing. (A) A multinodular architecture and well circumscribed masses with internal fibrous septa. (B) An abundant myxoid matrix containing round or slightly elongated cells with small hyperchromatic nuclei.
Mentions: Metastatic work-up was negative and the patient underwent left below knee amputation while awaiting the results of molecular testing. The amputation was planned because the location of the mass would have precluded skin closure. The mass was fully resected with negative margins. The resected tumor was tan-gray and bulging, measuring 9.0×7.0×5.5 cm. The cut surface of the tumor was tan-red and mucinous in appearance, with areas of hemorrhages. The tumor extended to the inter-digital area of the second and third toe and involved the articular surfaces of the distal metatarsal heads of the second and third toes. The skin, bone, and soft-tissue margins were grossly viable. The resected margins were negative. As per World Health Organization classification of the soft-tissue tumors, the tumor was identified as EMC (Figure 5). Mitotic rate was 5/10 high-power fields (HPF) and necrosis was present (extent 50%). Histologic grade as per French Federation of Cancer Centers Sarcoma Group (FNCLCC) was Grade 2. Pathologic staging was pT2bNX. The results of molecular testing were positive for rearrangement of EWSR1 gene at 22q12, thus confirming the diagnosis of EMC.

Bottom Line: The mass was fully resected with left below-knee amputation.A follow-up CT showed a new right breast nodule along with metastases to lung and bones.The results of the core needle biopsies of the right breast masses seen on mammogram were morphologically identical to extraskeletal myxoid chondrosarcoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.

ABSTRACT

Background: Extraskeletal myxoid chondrosarcoma is a unique and distinct clinicopathological entity in terms of its origin, morphology, and biologic behavior. Despite being a slow-growing tumor, it has a high rate of local recurrences and history of metastases to uncommon sites like the mandible, liver, retroperitoneum, right ventricle, pancreas, and central nervous system. Here, we report a very unique case of extraskeletal myxoid chondrosarcoma that metastasized to the breast, which itself is a very rare site for metastases.

Case report: A 58-year-old woman presented with a large, firm, and tender soft-tissue mass (6.0×7.0 cm) underneath the sole of the left foot. A computerized tomography (CT) scan showed a heterogeneous lobulated mass in the plantar aspect of the forefoot, measuring 8.6×8.0×7.1 cm. Punch biopsies revealed histology consistent with extraskeletal myxoid chondrosarcoma. Metastatic work-up was negative. The mass was fully resected with left below-knee amputation. The histology of the resected mass was consistent with extraskeletal myxoid chondrosarcoma. A follow-up CT showed a new right breast nodule along with metastases to lung and bones. The results of the core needle biopsies of the right breast masses seen on mammogram were morphologically identical to extraskeletal myxoid chondrosarcoma.

Conclusions: Although rare, metastases to the breast should be considered in the differential diagnosis of a breast mass. A close long-term follow-up is needed due to the unpredictable behavior of extraskeletal myxoid chondrosarcoma and the high frequency of local recurrences, metastases, and death due to disease.

No MeSH data available.


Related in: MedlinePlus