Differentials
Lung cancer
SIGNS / SYMPTOMS
Hemoptysis may occur.
Shortness of breath is a more common symptom, often related to a history of smoking.
INVESTIGATIONS
Chest x-ray or chest CT scan frequently demonstrates a single pulmonary lesion, often in the central bronchial region, in people with lung cancer.
Biopsy of the lesion consistent with lung tumor.
Presence of multiple pulmonary lesions is suggestive of metastatic breast cancer.
Osteosarcoma
SIGNS / SYMPTOMS
More likely to present in younger patients.
Usually affects weight-bearing bones (e.g., femur), whereas metastatic breast cancer can affect all bones, including nonweight-bearing bones (e.g., skull, ribs, sternum, scapula).[58].
INVESTIGATIONS
A single bone lesion, rather than multiple, on bone scan with or without a PET scan.
Biopsy may be necessary if a single lesion is present, to determine tumor origin.
Breast sarcoma
SIGNS / SYMPTOMS
Much less common than metastatic breast cancer.
More likely to have a history of radiation to the breast, and for lesions to develop within the irradiated area, and for there to have been a tumor-free-interval of at least 5 years after the end of radiation therapy.[59]
Unlike radiation-induced breast sarcoma, the risk of breast carcinoma relapse is highest in the first 2 to 3 years after surgery.[60]
INVESTIGATIONS
Biopsy with pathologic evaluation is required.
Brain cancer
SIGNS / SYMPTOMS
Absence of signs or symptoms of metastases at other sites (e.g., bone, liver).
INVESTIGATIONS
Brain metastases from metastatic breast cancer (MBC) often demonstrate ring enhancement on CT and MRI, whereas primary neoplasms of the brain generally do not demonstrate this effect.[61]
Brain cancer is more likely to present as a single brain lesion on imaging, rather than multiple lesions as with MBC.
Brain edema is common with glioblastoma, a form of primary brain cancer.
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