title: Tibial involvement in breast cancer: issues in diagnosis and management.
abstract: BACKGROUND
  Skeletal metastases below elbow and knee are uncommon, those to tibia are even rarer. Diagnosis may be delayed, and often confused with primary bone tumors (in solitary metastases) or with osteomyelitis or arthritis. Management depends on extent of disease and severity of symptoms. In most cases, treatment is essentially directed towards symptom relief.
  
  
  METHODS
  We describe a case of metastases to the tibia and foot in a case of breast cancer after a long disease-free period.
  
  
  RESULTS
  Roentgenogram appearance mimicked osteomyelitis, which was ruled out by absence of fever, sterile cultures and no response to antibiotics. Diagnosis was established by a bone biopsy, with immunohistochemistry demonstrating a carcinoma with estrogen and progesterone receptor positivity. The patient was managed with multiagent chemotherapy, hormone therapy, bisphosphonates and palliative radiotherapy. She remained stable for 1 year after which her disease progressed with cutaneous metastases, and she was given symptomatic treatment only.
  
  
  CONCLUSIONS
  Management of acrometastases from breast cancer involves a multimodality approach. Both systemic therapy and local therapy (in the form of surgery or radiation therapy) may help. Treatment needs to be individualized depending on prognosis and extent of disease.
authors.affiliation: Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India. drshikhagoyal@gmail.com
authors.forename: Shikha
authors.initials: S
authors.lastname: Goyal
authors.forename: Tarun
authors.initials: T
authors.lastname: Puri
authors.forename: Ruchika
authors.initials: R
authors.lastname: Gupta
authors.forename: Vaishali
authors.initials: V
authors.lastname: Suri
authors.forename: Pramod K
authors.initials: PK
authors.lastname: Julka
authors.forename: Goura K
authors.initials: GK
authors.lastname: Rath
mesh_terms: D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D013639:Tarsal Bones; D013977:Tibia