• Guebert GM
• Osterhouse MD

• Bone Neoplasms / secondary
• Breast Neoplasms / pathology
• Calcaneus / physiopathology
• Leg / physiopathology
• Leg Bones / physiopathology
• Pain / etiology

OBJECTIVE: To present a comprehensive look at the pathophysiology, clinical presentation, and treatment options for skeletal metastasis secondary to breast carcinoma by discussing the case of an 80-year-old female patient with bilateral distal lower extremity metastasis following a previous diagnosis of breast cancer.

CLINICAL FEATURES: The patient had severe pain in both lower extremities, which caused her to have difficulty when ambulating. She also complained of fatigue and anorexia, with an 8-lb weight loss. Chest examination revealed widespread rales without change. Her left calcaneus was tender to palpation and both feet and ankles were hot and swollen. Laboratory CA 27.29 values were 1131 on October 16, 2001, which was elevated compared with the 454 value obtained previously. Plain films of the lower extremities revealed destructive lesions of the distal left and right tibia and fibula with involvement of the left calcaneus. These findings were most consistent with metastasis.

INTERVENTION AND OUTCOME: The patient refused further care and sought a hospice referral. CONCLUSION: There is no cure for acrometastasis and prognosis is poor. Treatment focuses on symptomatic relief, extended survival, and maintaining quality of life. Clinicians should consider metastasis in a patient with distal lower extremity osteolytic lesions with a previous history of breast malignancy.

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