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Ossified diagnosis: sarcoidosis masquerading as metastatic breast cancer
  1. Meiling MacDonald-Nethercott1,
  2. Diana Ples1,
  3. Ramona Woitek2 and
  4. Emma Beddowes3
  1. 1School of Clinical Medicine, University of Cambridge, Cambridge, UK
  2. 2Department of Radiology, University of Cambridge, Cambridge, UK
  3. 3Department of Oncology, Cancer Research UK Cambridge Research Institute, Cambridge, Cambridgeshire, UK
  1. Correspondence to Dr Meiling MacDonald-Nethercott; mg390{at}cam.ac.uk; Dr Emma Beddowes; Emma.Beddowes{at}cruk.cam.ac.uk

Abstract

A 40-year-old woman was referred to the Breast Unit with a solid lump in her right breast. Investigations revealed an invasive lobular carcinoma. The patient underwent a right-sided mastectomy and sentinel lymph node (LN) biopsy, which confirmed axillary LN involvement. The postsurgery staging CT showed unusual enlargement of mediastinal and hilar LN bilaterally. This was consistent with positron emission tomography/CT and MRI, which further established the presence of several bone lesions. Determining the pathology within the LN and bones was pivotal in providing an accurate diagnosis and deciding subsequent management. However, histopathological analysis of the initial endobronchial ultrasound-guided fine-needle aspiration biopsy of mediastinal LN failed to identify definitive metastatic breast cancer cells. The case was extensively discussed in several multidisciplinary team meetings. Collective evidence, including clinical presentation, comparative imaging analysis, and further biopsies confirmed sarcoidosis with bone involvement-mimicking metastatic disease.

  • immunology
  • breast cancer
  • orthopaedics
  • radiology
  • respiratory medicine

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Footnotes

  • Contributors Patient was under the care of EB and the report was written by MM-N, DP, RW and EB. MM-N was responsible for drafting the paper and acquiring clinical information. MM-N, DP and EB revised and edited the report. RW contributed to the interpretation of the radiological findings. EB supervised the project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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