BONE-MARROW GRANULOMAS IN INFILTRATING LOBULAR BREAST-CANCER

A 50 year old woman with a history of infiltrating lobular breast carc inoma presented with back pain. Bone scan and magnetic resonance imagi ng were not conclusive. A bone marrow aspirate appeared normal. A rout ine trephine biopsy specimen showed granulomas but no obvious infiltra tion by carcinoma. Immunohistochemical staining with epithelial marker s demonstrated carcinoma cells in the trephine specimen. This case ill ustrates the difficulty of detecting infiltrating lobular carcinoma in bone marrow and the value of immunological techniques in this context . It also describes the development of bone marrow granulomas as a res ponse to infiltration by carcinoma.