Tibial involvement in breast cancer: Issues in diagnosis and management

Abstract 

Background

Skeletal metastases below elbow and knee are uncommon, those to tibia are even rarer. Diagnosis may be delayed, and often confused with primary bone tumors (in solitary metastases) or with osteomyelitis or arthritis. Management depends on extent of disease and severity of symptoms. In most cases, treatment is essentially directed towards symptom relief.

Method

We describe a case of metastases to the tibia and foot in a case of breast cancer after a long disease-free period.

Results

Roentgenogram appearance mimicked osteomyelitis, which was ruled out by absence of fever, sterile cultures and no response to antibiotics. Diagnosis was established by a bone biopsy, with immunohistochemistry demonstrating a carcinoma with estrogen and progesterone receptor positivity. The patient was managed with multiagent chemotherapy, hormone therapy, bisphosphonates and palliative radiotherapy. She remained stable for 1 year after which her disease progressed with cutaneous metastases, and she was given symptomatic treatment only.

Conclusion

Management of acrometastases from breast cancer involves a multimodality approach. Both systemic therapy and local therapy (in the form of surgery or radiation therapy) may help. Treatment needs to be individualized depending on prognosis and extent of disease.

Keywords: Breast cancer, Bone metastases, Tibia