We present a 44-year-old lady with multiple suspicious lesions in both breasts and history of lung carcinoid tumour, treated with upper lobectomy and whole chest radiotherapy. In the past 4 years, the patient was asymptomatic and free from metastatic disease.
During follow-up CT, several round-shaped, solid and hypervascular lesions were described in both breasts measuring between 8 mm and 15 mm.
A targeted breast US of the right breast was then performed; it revealed three suspicious solid nodules localized behind the nipple-areola complex, in the central lower and central outer quadrants respectively.
These findings appeared as low-echo nodules, with well-defined margins and vascular flow.
The lesion in the left breast was found to be a fibroadenoma.
Breast CE-MR confirmed the presence of three nodules in the right breast, one behind the right nipple-areola complex, one in the central lower quadrant and the last one in the central outer quadrant.
At CE-MR the lesions showed well-defined margins, low-intermediate signal on T2w sequences and heterogeneous enhancement after contrast agent administration. Two of them showed rim enhancement. IS/T type Ib curves were observed.
After CT, X-ray mammography was performed. According to the limits of dense breast, no significant findings were observed.
US revealed suspicious solid nodules, localized in the right breast.
US-guided biopsy was performed and the lesions were proved to be breast metastases from atypical carcinoid of the lung.
Breast MR was then performed in order to better evaluate the local extent of disease. No further lesions were identified.
Breast metastases from non-mammary tumours are quite unusual occurring in about 5% . The most common source of such metastases is melanoma; other extra-mammary cancers, which can metastasize more frequently to the breasts are non-Hodgkin lymphoma, sarcoma, stomach carcinoma and ovarian tumours.
The patient history can be helpful to better differentiate breast metastases from primary lesions.
Only few cases of breast metastases from atypical carcinoid of the lung were described [2, 3].
There is no specific clinical perspective in breast metastatic disease from lung carcinoid, with the exception for nodules appearing as palpable mass or infiltrating the skin.
Carcinoid metastases to the breast can appear as well-defined masses at X-ray mammography and as low echo lesions with well-defined margins.
CE-MR findings may be similar to a primary breast cancer .
Differential Diagnosis List
Primary breast lesions (IDC)
Metastatic lesions from lymphoma
from ovarian cancer
from gastric cancer
from renal cell cancer