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Jumping to conclusions: Misdiagnosing radiation induced sarcoma as recurrent breast cancer

  • Komal Chughtai
    Correspondence
    Corresponding author at: 825 Marshall St Apt 332, Redwood City, CA 94063-2168, United States of America.
    Affiliations
    Department of Radiology, Stanford University Medical Center, Stanford, CA, United States of America
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  • Author Footnotes
    1 453 Quarry Rd., Stanford, California 94305, Mailbox 5621.
    Lindsey Negrete
    Footnotes
    1 453 Quarry Rd., Stanford, California 94305, Mailbox 5621.
    Affiliations
    Department of Radiology, Stanford University Medical Center, Stanford, CA, United States of America
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  • Author Footnotes
    2 875 Blake Wilbur Dr, Stanford, California 94305, Mailbox 5847.
    Lucas Kas Vitzthum
    Footnotes
    2 875 Blake Wilbur Dr, Stanford, California 94305, Mailbox 5847.
    Affiliations
    Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States of America
    Search for articles by this author
  • Author Footnotes
    1 453 Quarry Rd., Stanford, California 94305, Mailbox 5621.
    2 875 Blake Wilbur Dr, Stanford, California 94305, Mailbox 5847.
Published:February 11, 2022DOI:https://doi.org/10.1016/j.clinimag.2022.01.014

      Highlights

      • Radiation induced chest wall chondrosarcoma is a very rare but important complication of radiation therapy for breast cancer.
      • There is often a long latency period between radiation treatment and emergence of a secondary sarcoma.
      • Patients are often presumptively diagnosed with local breast cancer recurrence.
      • Diagnostic criteria for radiation induced sarcoma is discussed.

      Abstract

      Radiation therapy (RT) induced chondrosarcoma is a rare but important potential complication seen in cancer patients treated with radiation. Although uncommon, these patients tend to have a poor prognosis, so early detection and complete resection are the crucial steps towards survival. We present the case of an 81-year-old breast cancer patient who was treated with RT to the left chest wall. Eight years later, she presented with a growing left chest wall mass, initially thought to represent local breast cancer recurrence. Imaging demonstrated a well-defined mass arising from the left pectoralis major muscle. The mass was excised, and pathology demonstrated chondrosarcoma. We discuss the clinical and radiologic aspects of RT-induced sarcomas with attention to the very rare chondrosarcoma. The aim of this report is to provide a succinct but relevant summary of the diagnostic considerations for RT-induced sarcoma supported by information about epidemiology, clinical diagnostic criteria, and radiation biology to expedite patient workup and ultimately improve patient outcomes.

      Keywords

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