Breast Cancer - Breast Case 5

History:
41 year old female with a history of breast cancer, status post lumpectomy and axillary node dissection, and radiation treatment was referred for a restaging PET/CT examination. Metastatic breast cancer with ovarian metastases



Imaging Findings:
Radiopharmaceutical Administered: 11.35mCi ¹⁸F FDG IV.

Technique: Emission scanning from the neck through the pelvis was obtained approximately one hour post injection. Images were reconstructed with and without attenuation correction using the CT coefficients from the corresponding CT portion of the exam. Patient's blood glucose measured 96mg/dl.

Findings: There was a focal area of moderately increased uptake of FDG noted in the left lower cervical area in the lower neck. There was also a focal area of increased uptake in the right supraclavicular area. There was a large area of intense increased uptake in the right paratracheal area as well as areas of uptake in the subcarinal area, AP window, and bilateral hilar areas. These areas all corresponded to nodes in those areas. The small axillary nodes seen on the CT portion of the exam did not demonstrate increased uptake of FDG. There was a focal area of moderately increased uptake of FDG noted in the right humerus, mid shaft. There were approximately six foci of intense increased uptake of FDG noted in the liver, the largest one which has an area of central photopenia consistent with necrosis. These six liver lesions were bilobar and corresponded to the six lesions seen on the CT portion of the exam. There was a large area of intense increased uptake of FDG noted in the left adrenal gland corresponding to the mass seen on the CT portion of the exam. There were very large areas of intense increased uptake noted in the ovaries bilaterally consistent with metastatic disease to the ovaries. There are additional osseous foci of increased uptake noted in the right acetabulum and in the iliac bones bilaterally.

The multiple foci of increased uptake of FDG as listed above were consistent with diffuse metastatic disease, but several lesions identified on the PET/CT study were unseen on CT alone. Incidentally, this patient had bilateral ovarian metastases from breast cancer, otherwise known as Krukenburg tumors.

Data courtesy of Dr. Todd Blodgett, University of Pittsburgh Medical Center