Osteoblastic lesions: utility of bone densitometry in an unusual presentation of breast carcinoma

Abstract

Osteoblastic lesions secondary to malignant disease are easily detectable. In breast cancers, when there are skeletal metastasis, the patient tends to be very compromised clinically and additional studies quickly clarify the diagnosis. However there are cases in which metastases are not easy to diagnose. We report the case of a patient with recurrent breast carcinoma, consulting seven years later following changes in the DXA and nonspecific pain. It drew our attention the increase in densitometric values, 21% in lumbar spine and 2.2% in the femoral neck from 2005 to 2012, unusual data without osteoactive treatment. Suspecting alteration in osteoarticular system we requested Rx of spine and hip that showed suspicious osteoblastic images. We requested a bone scan that was negative and complete laboratory studies that were normal. The same osteocondensing images existed in a prior Rx of pelvis but in lesser magnitude. While oncologists and gynecologists ruled out secondaries, unexplained increases in DXA values and radiological changes in images led us to perform a needle biopsy of iliac crest that confirmed metastatic breast carcinoma. The value of the presentation is the suspicion of the final diagnosis due an unexpected increase of densitometric values.