Axilalry Lymph Node Metastatsis in Primary Osteogenic Sarcomas of the Breast
S Sanati, SY Zaidi, FA Tavassoli. Yale University School of Medicine, New Haven, CT; Sinai Grace Hospital, Detroit Medical Center, Wayne State University, Detroit, MI
Background: Pure mammary osteogenic sarcomas are rare, representing a fraction of 1% of primary breast malignancies. Regional lymph node metastasis has rarely been documented in primary breast osteosarcomas. Against this background, a small series is presented that includes one case with axillary lymph node metastasis. Features of this case that may explain the nodal metastasis are discussed.
Design: The surgical pathology files of our institution from 1988 to 2008 were searched and the cases of osteogenic sarcoma were retrieved. Pathology material were reviewed and clinical information including MRI, mammographic findings, and clinical follow up were obtained. The possibility of metaplastic carcinoma was excluded by using appropriate immunostains. None of the tumors had a phylloides component.
Results: All patients were women who ranged in age from 32-85 years (mean= 58). Six tumors were in the left and one in the right side. Initial treatment ranged from incisional biopsy (n=2) to mastectomy (n=5); one of the former had subsequent completion mastectomy. Tumor size ranged from 2.8 to 17 cm (mean= 7.3 cm). Mitotic figures ranged from 20-60/ 10 HPF. Five cases had marked cytologic atypia. Five cases were of osteoblastic and 2 of osteoclastic type. The 17 cm tumor with ulceration through the areolar region of the breast had metastatic disease in one of ten axillary lymph nodes. There was no direct extension to the axillary node by the tumor. Follow up was available in 4 cases: bone metastasis developed within 3 years in one case, one patient died of disease within a month of surgery due to complications of surgery (the case with axillary lymph node metastasis), and two patients are alive with no evidence of disease 2 years post diagnosis.
Conclusions: The presence of axillary lymph node metastasis in one of the 7 tumors in our series is a most unusual finding given the rarity of lymph node involvement associated with sarcomas in general and osteogenic sarcomas in particular. It is postulated that involvement of the areolar skin, where a rich lymphatic network exists, is the major factor responsible for lymph node metastasis.
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 70, Tuesday Morning