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Review
. 2015 Oct 20;5(3):223-6.
doi: 10.11138/mltj/2015.5.3.223. eCollection 2015 Jul-Sep.

Enthesopathy of the pectoralis major tendon mimicking osteoid osteoma. A case report with an unfortunate series of events

Daniel Baumhoer  1 , Gernot Jundt  1 , Ulrich Lenze  2 , Clemens Reisinger  3 , Anna Hirschmann  3
Affiliations
Review

Enthesopathy of the pectoralis major tendon mimicking osteoid osteoma. A case report with an unfortunate series of events

Daniel Baumhoer et al. Muscles Ligaments Tendons J. .

Abstract

Background: we present the case of an enthesopathy at the proximal humerus which was initially - due to the clinical history and a positive bone scintigraphy - regarded suspicious for metastatic breast cancer in a 50-year-old woman.

Case report: after complementing radiographs and a magnetic resonance (MR) examination exhibiting a focally contrast enhancing juxtacortical osteolysis of the humerus, a metastasis seemed radiologically unlikely, but besides a traction-related periosteal reaction of the pectoralis major tendon an unusual osteoid osteoma could not unequivocally be ruled out. Although radiological follow-up was recommended the patient insisted on a surgical resection that was performed subsequently and confirmed an enthesopathy. Shortly after, she fractured her upper arm following minor trauma but is doing well after conservative treatment since then.

Conclusion: enthesopathies presenting as unusual periosteal reactions can mimic primary and secondary bone tumors and should always be included in the differential diagnosis.

Keywords: bone scan; enthesopathy; metastases; osteoid osteoma; pectoralis major tendon; secondary fracture.

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Figures

Figure 1
Figure 1
A 50-year-old woman with chronic back pain and clinical history of breast cancer three years ago underwent a 99m Technetium DPD bone scintigraphy with a focal bone tracer uptake (arrow) of the left proximal lateral humerus shown on the whole body scan (A) as well as on the spot view (B).
Figure 2
Figure 2
External rotation anteroposterior radiograph of the left humerus shows a focal juxtacortical lucency (arrow) surrounded by a smooth, uniform non-aggressive periosteal reaction.
Figure 3
Figure 3
MR images show a small, 5 × 4 mm juxtacortical lesion (arrows) of the anterolateral humerus at the insertion of the pectoralis major tendon (arrowheads in B) with increased signal intensity on the T2 fat suppressed image (A), slight increased signal intensity on the T2 image (B), intermediate signal intensity on the T1 image (C) and enhancement after contrast administration (D). The underyling cortex is slightly thinned.
Figure 4
Figure 4
Histology of the resection specimen revealed an osteoid osteoma-like reactive new bone formation directly at the insertion of the pectoralis major tendon (A, H&E stain, ×1 magnification). Higher magnification shows residual lamellar bone (arrowheads) surrounded by irregular woven bone (B, H&E stain, ×50 magnification) and a well vascularized fibrous stroma without atypical cells (C, H&E stain, ×200 magnification).
See this image and copyright information in PMC

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