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Practice

Osseous sarcoidosis mimicking metastatic breast cancer

Henry Li, Laurence Stillwater, Mark Bryanton and Christina A. Kim
CMAJ July 13, 2020 192 (28) E799-E802; DOI: https://doi.org/10.1503/cmaj.191661
Henry Li
Max Rady College of Medicine (Li) and Department of Internal Medicine (Kim), Rady Faculty of Health Sciences, University of Manitoba; Sections of Adult Radiology (Stillwater) and Nuclear Medicine (Bryanton), Department of Radiology, University of Manitoba; Research Institute in Oncology and Hematology (Kim), Cancer-Care Manitoba, Winnipeg, Man.
BSc
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Laurence Stillwater
Max Rady College of Medicine (Li) and Department of Internal Medicine (Kim), Rady Faculty of Health Sciences, University of Manitoba; Sections of Adult Radiology (Stillwater) and Nuclear Medicine (Bryanton), Department of Radiology, University of Manitoba; Research Institute in Oncology and Hematology (Kim), Cancer-Care Manitoba, Winnipeg, Man.
MD
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Mark Bryanton
Max Rady College of Medicine (Li) and Department of Internal Medicine (Kim), Rady Faculty of Health Sciences, University of Manitoba; Sections of Adult Radiology (Stillwater) and Nuclear Medicine (Bryanton), Department of Radiology, University of Manitoba; Research Institute in Oncology and Hematology (Kim), Cancer-Care Manitoba, Winnipeg, Man.
MD
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Christina A. Kim
Max Rady College of Medicine (Li) and Department of Internal Medicine (Kim), Rady Faculty of Health Sciences, University of Manitoba; Sections of Adult Radiology (Stillwater) and Nuclear Medicine (Bryanton), Department of Radiology, University of Manitoba; Research Institute in Oncology and Hematology (Kim), Cancer-Care Manitoba, Winnipeg, Man.
MD
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    Figure 1:

    Delayed technetium 99m-methyl diphosphonate (99mTc-MDP) whole-body skeletal scans in a 49-year-old woman with ductal carcinoma of the right breast. (A) MDP-avid lesions in the right iliac bone, right ischium and right proximal humeral metaphysis (arrows). (B) Two years later, the lesions were essentially unchanged.

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    Figure 2:

    Axial (A) and coronal (B) computed tomography (CT) images of the chest, showing micronodular pulmonary nodules in a peribronchovascular perilymphatic distribution. (C) Axial CT image of the chest, showing a prominent right hilar lymph node with no calcifications (arrow).

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    Figure 3:

    Coronal computed tomography images of the chest. (A) Possible small lucent lesion within the T10 vertebral body (arrow). (B) Image 2 years later shows a mixed lucent and sclerotic lesion about the right lateral aspect of the T10 vertebral body (arrow) and a lucent focus about the left lateral aspect of the T6 vertebral body (arrowhead).

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    Figure 4:

    Magnetic resonance imaging views. (A) Sagittal T1-weighted images of the thoracic and lumbar spine, showing multiple low-signal lesions in multiple vertebrae. (B) On sagittal T2-weighted images, all of these lesions show low signal intensity. (C) Sagittal T1-weighted fat-saturated postcontrast images, showing that all of these lesions enhanced after administration of gadolinium. (D) Axial T1-weighted image of the sacrum, showing low-signal lesions within the right sacrum and right iliac bone. (E) Axial T1-weighted fat-saturated image, showing that the sacral and iliac lesions enhanced after administration of gadolinium.

  • Figure 5:
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    Figure 5:

    Biopsy specimen of the right iliac bone, showing multiple non-caseating granulomas (arrows) including multinucleated giant cells (hematoxylin–eosin, 20× magnification).

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Canadian Medical Association Journal: 192 (28)
CMAJ
Vol. 192, Issue 28
13 Jul 2020
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Osseous sarcoidosis mimicking metastatic breast cancer
Henry Li, Laurence Stillwater, Mark Bryanton, Christina A. Kim
CMAJ Jul 2020, 192 (28) E799-E802; DOI: 10.1503/cmaj.191661

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Osseous sarcoidosis mimicking metastatic breast cancer
Henry Li, Laurence Stillwater, Mark Bryanton, Christina A. Kim
CMAJ Jul 2020, 192 (28) E799-E802; DOI: 10.1503/cmaj.191661
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