Breast Osteosarcoma 29 Years after Radiation Therapy for Epithelial Breast Cancer
We present the case of an 87-year-old African American female with a past medical history of right breast adenocarcinoma diagnosed in 1989. At that time, the patient underwent partial mastectomy, axillary lymph node dissection and radiation therapy. The patient had yearly surveillance and diagnostic mammograms with no evidence of disease recurrence. Her past medical history is also significant for hypertension and type 2 diabetes mellitus. The patient's family history is significant for breast cancer in her sister at the age of 40 years and hypertension in both of her parents. The patient was using metformin, low-dose aspirin, lisinopril and hydrochlorothiazide.\nIn October 2011, a 10-cm tender right breast mass was noted by the patient. She subsequently underwent modified radical mastectomy of the right breast after thorough medical evaluation of the mass (fig. ). The pathology report was consistent with chondroblastic osteosarcoma (fig. ). The tumor stained positive for vimentin and negative for cytokeratin.\nEight months later, the patient had a recurrence of the lesion and a re-excision was performed with clear margins. A pathology report of the recurrent breast mass was consistent with breast osteosarcoma. Eight months after the second surgery, the patient started having fatigue and dry cough. A computed tomography of the chest was performed and showed bilateral pulmonary nodules suspicious for a malignancy (fig. ). A biopsy of the nodules revealed metastatic osteosarcoma (fig. ). The patient was started on liposomal doxorubicin chemotherapy. Transthoracic echocardiography was performed prior to doxorubicin initiation, given potential cardiotoxic effects of doxorubicin. Transthoracic echocardiography showed a normal heart function. The patient tolerated chemotherapy well and is scheduled for the next visit in 2 months.