Osteopoikilosis masquerading as osseous metastases in breast cancer

Abstract

Osteopoikilosis (OPK) is a rare, congenital bone disorder characterised by multiple round or ovoid radio densities appearing throughout the axial and appendicular skeleton. It is usually an asymptomatic condition diagnosed incidentally on radiological imaging, and may mimic other bone disorders, including osseous metastases. In this case report, we present a patient with lobular breast cancer whose computed tomography findings were thought to be consistent with osseous cancer metastases. Radionuclide bone scintigraphy plays a key role in distinguishing OPK from osteoblastic bone metastases. This case demonstrates the importance of a clinical awareness of OPK to ensure that patients with potentially curable disease are properly diagnosed.

Disseminierte osteoblastische Knochenherde – Probleme bei der Diagnose der Osteopoikilie

“…ein Malignom bekannt ist. Hier ist aufgrund des radiologischen Erscheinungsbildes der Osteopoikilie eine Abgrenzung von osteoblastischen Knochenmetastasen oft nur schwer möglich (6,13). In den Fällen, in denen zur weiteren Abklärung der sklerotischen Ver-änderungen eine Szintigrafie angefertigt wurde, blieb diese meistens negativ.…”

Osteopoikilosis: A Benign Condition With the Appearance of Metastatic Bone Disease

“…1,2 The incidence of osteopoikilosis is estimated to be 1 in 50,000. 3 These lesions are most often discovered incidentally on radiographic imaging. Patients are usually asymptomatic or may complain of nonspecific bony aches.…”

“…5 Although osteopoikilosis may have the appearance of sclerotic metastatic disease to the bone on plain films and CT, the lesions are classically inactive on scintigraphy. 1,3,6 As such, a Tc-99m bone scan is sufficiently diagnostic and usually returns normal in cases of osteopoikilosis. There have been a few cases reported in literature of abnormal bone scans in patients with osteopoikilosis.…”

“…5 In addition, fluorodeoxyglucosepositron emission tomography scan is normal and can further support the case for benign bone lesions. 3 It is important for the oncology community to be aware of this rare and benign condition to prevent misdiagnosis.…”