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16 December 2011 - Case of the Week #227
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Thanks to Dr. Semir Vranic, Clinical Center of the University of Sarajevo (Bosnia), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
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Case of the Week #227
A 60 year old woman with no history of malignancy, kidney disease or other medical disorders presented with a tumor mass in the upper outer quadrant of her left breast measuring 30x25 mm. Previous mammography revealed massive calcification with a benign appearance. A wide excision was performed. Frozen section revealed no definite diagnosis.
What is your diagnosis?
Osseous metaplasia of the breast
The specimen contains well-formed bone tissue without associated neoplasia.
Osseous metaplasia is uncommon. It is associated with benign lesions, including cholesterol granuloma (Pathol Res Pract 2008;204:353), fibroadenoma (Radiology 1989;172:671), fasciitis ossificans (Pathol Res Pract 2007;203:737, Arch Pathol Lab Med 2004;128:e29), lipogranuloma (Yonsei Med J 2011;52:373), radiation therapy (Br J Radiol 2002;75:460), saline implants (Plast Reconstr Surg 2001;107:356) and silicone implants (Ann Plast Surg 1998;41:348).
Osseous metaplasia is also associated with metaplastic carcinoma and other invasive subtypes (Breast 2008;17:314, Am J Surg Pathol 2009;33:534), as well as osteosarcoma of the breast (Cases J 2008 Aug 9;1(1):80).
This disorder is benign, but it is important to exclude a possible associated malignancy, which may not be evident on a core biopsy.
Nat Pernick, M.D., President
and Liz Parker, B.A., Associated Medical Editor
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: NatPernick@gmail.com