Figure 1
Follow-up CT
Breast metastases from lung carcinoma
SectionBreast imaging
Case TypeClinical Cases
AuthorsA. Castrignanò, S. Liberali, M.L. Luciani, M. Telesca, F. Pediconi, C. Catalano
Connected authors
44 years, female
Clinical History
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.
Imaging Findings
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.
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.
Discussion
CASE MANAGEMENT
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% [1]. 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].
CLINICAL PERSPECTIVE
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.
IMAGING PERSPECTIVE
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 [4].
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% [1]. 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].
CLINICAL PERSPECTIVE
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.
IMAGING PERSPECTIVE
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 [4].
Differential Diagnosis List
Metastases
Primary breast lesions (IDC)
Metastatic lesions from lymphoma
from ovarian cancer
from gastric cancer
from renal cell cancer
Phylloid tumour
Final Diagnosis
Metastases
References
[1] Feder JM, de Paredes ES, Hogge JP, Wilken JJ (1999) Unusual breast lesions: radiologic-pathologic correlation. Radiographics (PMID: 10517440)
[2] Geyer HL, Viney J, Karlin N (2010) Metastatic carcinoid presenting as a breast lesion. Curr Oncol (PMID: 21151413)
[3] Wozniak TC, Naunheim KS (1998) Bronchial carcinoid tumor metastatic to the breast. Ann Thorac Surg (PMID: 9564951)
[4] Glazebrook KN, Jones KN, Dilaveri CA, Perry K, Reynolds C (2011) Imaging features of carcinoid tumors metastatic to the breast. Cancer Imaging (PMID: 21771708)
Case information
| URL: | https://www.eurorad.org/case/10902 |
| DOI: | 10.1594/EURORAD/CASE.10902 |
| ISSN: | 1563-4086 |
Figure 2
Major lesion of the right breast
Figure 3
The lesion in the left breast
TSE T2 weighted STIR sequence on axial plane: in the left breast, in the inner upper quadrants, there is a 15 mm round mass with regular margins and very low signal intensity.
Post contrast Vibe T1 weighted sequence shows a round mass in the left inner upper quadrant, with regular margins, intermediate signal intensity, which is suggestive of a fibroadenoma.
Figure 4
Dynamic Vibe T1 weighted sequence
Dynamic Vibe T1 weighted sequence shows three nodules in the right breast, behind the right nipple-areola complex and between the lower and the outer quadrants; a heterogeneous contrast uptake with rim enhancement is seen.
Dynamic Vibe T1 weighted sequence shows three nodules in the right breast, behind the right nipple-areola complex and between the lower and the outer quadrants; a heterogeneous contrast uptake with rim enhancement is seen.
Dynamic Vibe T1 weighted sequence shows three nodules in the right breast, behind the right nipple-areola complex and between the lower and the outer quadrants; a heterogeneous contrast uptake with rim enhancement is seen.
Follow-up CT
Axial CT image shows a solid and hypervascular mass in the upper inner quadrant of the right breast.
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Axial CT image shows another solid mass, with no CE, localized between the upper quadrants of the left breast.
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Major lesion of the right breast
TSE T2 weighted STIR sequence: in the right breast, behind the right nipple-areola complex, a well-defined mass with low-intermediate signal intensity is seen.
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Vibe T1 weighted sequence on axial plane shows a round area, with regular margins and intermediate signal intensity.
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
The lesion in the left breast
TSE T2 weighted STIR sequence on axial plane: in the left breast, in the inner upper quadrants, there is a 15 mm round mass with regular margins and very low signal intensity.
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Post contrast Vibe T1 weighted sequence shows a round mass in the left inner upper quadrant, with regular margins, intermediate signal intensity, which is suggestive of a fibroadenoma.
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Dynamic Vibe T1 weighted sequence
Dynamic Vibe T1 weighted sequence shows three nodules in the right breast, behind the right nipple-areola complex and between the lower and the outer quadrants; a heterogeneous contrast uptake with rim enhancement is seen.
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Dynamic Vibe T1 weighted sequence shows three nodules in the right breast, behind the right nipple-areola complex and between the lower and the outer quadrants; a heterogeneous contrast uptake with rim enhancement is seen.
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Dynamic Vibe T1 weighted sequence shows three nodules in the right breast, behind the right nipple-areola complex and between the lower and the outer quadrants; a heterogeneous contrast uptake with rim enhancement is seen.
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
Department of Radiological Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy
