A Case Report of Solitary Bone Metastasis from Primary Angiosarcoma of the Bilateral Breasts – A Rare Diagnosis

Case Report | Volume 7 | Issue 1 | JBST January – April 2021 | Page 16-21 | Katrina Ysabel R Naraval, Daniela Kristina D. Carolino, Ma. Lilia Molina P. Jose. DOI: 10.13107/jbst.2021.v07i01.43

Author: Katrina Ysabel R Naraval[1], Daniela Kristina D. Carolino[1], Ma. Lilia Molina P. Jose[1], [2]

[1]Institute of Orthopaedics and Sports Medicine, St. Luke’s Medical Center, 279 E. Rodriguez Sr. Blvd., Quezon city 1112, Philippines,
[2]Orthopaedic Oncology section, Department of Orthopaedics, The Medical City Clark, Pampanga, Philippines.

Address of Correspondence
Dr. Katrina Ysabel R Naraval,
Institute of Orthopaedics and Sports Medicine, St. Luke’s Medical Center, 279 E. Rodriguez Sr. Blvd., Quezon city 1112, Philippines.
E-mail: khayanaraval@gmail.com


Abstract

Introduction: Primary angiosarcoma of the breast is an uncommon subtype of soft-tissue sarcoma known to be aggressive and is associated with distant metastasis and poor prognosis. Solitary bone metastases occurring in these cases are even more rare with the available limited literature based from small retrospective case series.
Case Report: We present a case of a 24-year-old Filipino female previously diagnosed with primary angiosarcoma of the bilateral breasts, initially presenting with a 3-month history of the right hip pain and consulted due to a pathologic fracture of the right proximal femur. Diagnostic tests done confirmed solitary skeletal metastasis to this area, for which she underwent wide resection and application of a proximal femoral endoprosthesis. Postoperatively, the patient was able to independently ambulate, with follow-up radiographs showing stable implant fixation. Further imaging showed that lesion-free bones, however, noted development of distant recurrence manifesting with pulmonary metastases and hemorrhagic subcutaneous lesions 3 months after. Adequate tumor resection and radiotherapy are reported to successfully treat isolated skeletal metastasis in the proximal femur. The presence of the pathologic fracture before definitive treatment may have contributed to its distant recurrence, in addition to an already aggressive nature of the primary malignancy.
Conclusion: In the background of primary breast angiosarcoma, although rare, high suspicion for isolated skeletal metastasis in a symptomatic patient prevents delay in definitive management, which avoids progression to a poorer prognosis.
Keywords: Solitary bone metastasis, angiosarcoma, proximal femur, pathologic fracture.


References:

1. Bordoni D, Bolletta E, Falco G, Cadenelli P, Rocco N, Tessone A, et al. Primary angiosarcoma of the breast. Int J Surg Case Rep 2016;20:12-5.
2. An I, Harman M, Ibiloglu I. Topical ciclopirox olamine 1%: Revisiting a unique antifungal. Indian Dermatol Online J 2017;10:481-5.
3. Kunkiel M, Maczkiewicz M, Jagiełło-Gruszfeld A, Nowecki Z. Primary angiosarcoma of the breast-series of 11 consecutive cases-a single-centre experience. Curr Oncol 2018;25:e50-3.
4. Bhosale SJ, Kshirsagar AY, Patil MV, Wader JV, Nangare N, Patil PP. Primary angiosarcoma of breast: A case report. Int J Surg Case Rep 2013;4:362-4.
5. Zahir ST, Sefidrokh Sharahjin N, Rahmani K. Primary breast angiosarcoma: Pathological and radiological diagnosis. Malays J Med Sci 2014;21:66-70.
6. Gaballah AH, Jensen CT, Palmquist S, Pickhardt PJ, Duran A, Broering G, et al. Angiosarcoma: Clinical and imaging features from head to toe. Br J Radiol 2017;90:20170039.
7. Wang L, Lao IW, Yu L, Wang J. Clinicopathological features and prognostic factors in angiosarcoma: A retrospective analysis of 200 patients from a single Chinese medical institute. Oncol Lett 2017;14:5370-8.
8. Hosaka S, Katagiri H, Honda Y, Wasa J, Murata H, Takahashi M. Clinical outcome for patients of solitary bone only metastasis. J Orthop Sci 2016;21:226-9.
9. Vincenzi B, Santini D, Schiavon G, Frezza AM, Dileo P, Silletta M, et al. Bone metastases in soft tissue sarcoma patients: A survey of natural, prognostic value, and treatment. J Clin Oncol 2012;30 Suppl 15:10063.
10. Guzik G. Oncological and functional results after surgical treatment of bone metastases at the proximal femur. BMC Surg 2018;18:2-9.
11. Li N, Cusidó MT, Navarro B, Tresserra F, Baulies S, Ara C, et al. Breast sarcoma. A case report and review of literature. Int J Surg Case Rep 2016;24:203-5.
12. Saimura M, Mitsuyama S, Anan K, Koga K, Ono M, Toyoshima S. A rare case of rapidly progressing angiosarcoma of the breast with multiple metastases to the bone, liver, ovary, and gingiva. Int Cancer Conf J 2012;1:159-63.
13. Soeharno H, Povegliano L, Choong PF. Multimodal treatment of bone metastasis-a surgical perspective. Front Endocrinol (Lausanne) 2018;9:518.
14. Khattak MJ, Ashraf U, Nawaz Z, Noordin S, Umer M. Surgical management of metastatic lesions of proximal femur and the hip. Ann Med Surg (Lond) 2018;36:90-5.
15. Pramanik R, Gogia A, Malik PS, Gogi R. Metastatic primary angiosarcoma of the breast: Can we tame it the metronomic way. Indian J Med Paediatr Oncol 2017;38:228-31.
16. Apice G, Pizzolorusso A, di Maio M, Grignani G, Gebbia V, Buonadonna A, et al. Confirmed activity and tolerability of weekly paclitaxel in the treatment of advanced angiosarcoma. Sarcoma 2016;2016:6862090.
17. Yu Z, Xiong Y, Shi R, Min L, Zhang W, Liu H, et al. Surgical management of metastatic lesions of the proximal femur with pathological fractures using intramedullary nailing or endoprosthetic replacement. Mol Clin Oncol 2017;8:107-14.
18. Sarahrudi K, Hora K, Heinz T, Millington S, Vécsei V. Treatment results of pathological fractures of the long bones: A retrospective analysis of 88 patients. Int Orthop 2006;30:519-24.


How to Cite this article: Naraval KYR, Carolino DKD, Jose MLMP | A Case Report of Solitary Bone Metastasis from Primary Angiosarcoma of the Bilateral Breasts – A Rare Diagnosis | Journal of Bone and Soft Tissue Tumors | Jan-Apr 2021; 7(1): 16-21.

[Full Text HTML] [Full Text PDF] [XML]