An affluent 59 year old lady presented with vague heaviness in the left breast. CBE did not reveal any palpable mass. XRM was reported normal on right with a small nodular lesion on the left possibly a fibroadenoma. US screening also did not reveal any demonstrable suspicious mass.
Relook X-Ray mammography reveals subtle architectural distortion in the upper outer quadrant of the left breast with a small nodular lesion at 11’o clock axis reported as fibroadenoma.
The first minute subtracted MIP (A) and post-contrast FS GRE (InterVIEWS) (B, C, D) reveal an enhancing nodular lesion with mixed plateau and washout kinetics at 10-11’0 clock position corresponding to the nodular lesion on XRM. No mass-like enhancement was seen involving the parenchyma in the upper outer and lower outer quadrant at mid breast depth and showing slow persistent kinetics. It corresponded to the architectural distortion on XRM.
The STIR images (E) of the breast revealed focal altered intensity marrow lesions involving the visualized humerus, clavicles, and sternum, and MR morphological features suggested a neoplastic etiology.
Subsequent MRI (F, G) of the whole spine revealed altered intensity marrow infiltration of the entire visualized axial and appendicular skeleton. US gx biopsy for the architectural distortion on second look ultrasound revealed Invasive lobular carcinoma.
Bone marrow biopsy was done which revealed metastatic carcinoma. Subsequently, an FDG PET/CT(H) was done for staging workup which revealed FDG uptake neither in the primary breast lesion nor in the bony metastasis.
This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).
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