A healthy, 40-year-old female, with breast implants, went to the Emergency Ward, presenting oppressive and intermittent postprandial epigastric pain, with 3-week evolution (denied other constitutional symptoms or complaints). Physical examination was unremarkable, but the abdominal X-ray showed osteoblastic lesions in the pelvis (Fig. 1). Consequently, the patient was submitted to a thoraco-abdominopelvic tomography (Fig. 2) that showed lesions sugestive of diffuse metastasis without evidence of a primary lesion or other foci of metastasis. The complementary studies, to help defining primary neoplasia, revealed no changes. For aetiological clarification of the bone lesions a bone biopsy was performed suggesting osteopoikilosis, as well as a bone scintigraphy that showed no fixation foci suggestive of metastasis. However, a breast resonance, due to breast implants, was performed which surprisingly revealed a mammary nodule with an anatomopathological examination compatible with invasive lobular carcinoma.

Osteopoikilosis is a benign and rare autosomal dominant osteosclerotic dysplasia, without prevalence of sex.^1,2 At presentation, patients are usually asymptomatic, and lesion are often an incidental finding.³ Well-defined sclerotic lesions clustered symmetrically around joints and throughout the appendicular skeleton and pelvis.² A differential diagnosis should be considered, especially against osteoblastic metastasis, which present high scintigraphic activity.^2-4

In the described case, there were lesions in the spine, which according to the literature aren’t typical, which led to an exhaustive investigation in search of its etiology, more specifically a primary neoplasm.^1-4 Including the performance of bone biopsy and scintigraphy, that proved to be lesions compatible with Osteopoikilosis. Coincidentally the patient had a breast-cancer that was eventually diagnosed.

Despite being benign lesions and is not necessary follow-up or another studies and treatment none required, an early recognition is essential to prevent unnecessary emotional distress.⁵ In this case, the whole investigation became beneficial for the patient, with the diagnosis of breast-cancer at a still asymptomatic stage.

Figura I

Left on Figure 1 a Pelvic X-ray and Right on Figure 2 a Abdominopelvic tomography showing osteoblastic lesions.

  BIBLIOGRAFIA  

1. Stephen Wallace; Richard B. Towbin; and Alexander J. Towbin. Osteopoikilosis. APPLIED RADIOLOGY, pediatric radiological case, March-April 2019

2. Cravo A C, Villacreses C, Silva J C. Osteopoiquilode: dois casos clínicos. ÓRGÃO OFICIAL DA SOCIEDADE PORTUGUESA DE REUMATOLOGIA - ACTA REUM PORT. 2006;31:255-60

3. Mahbouba J, Mondher G, Amira M, et al. Osteopoikilosis: A rare cause of bone pain. Caspian J Intern Med 2015; 6(3):177-9.

4. Pires Carvalho A C, Santos Beze R, Estevam Picinini S. Osteopoiquilose – Apresentação de um caso e revisão da literatura. Radiol Bras 2002;35(3):191–2

5. N. DAL PIZZOL, M.M. DAL PIZZOL. Osteopoiquilose: relato de caso. Rev Bras Ortop_Vol. 37, No 10 – Outubro, 2002.