Case Author(s): Samuel Wang, M.D. and Barry A. Siegel, M.D., . Rating: #D3, #Q3

Diagnosis: Poorly differentiated infiltrating ductal breast carcinoma with metaplastic changes.

Brief history:

61-year old woman with a large breast mass


Anterior and posterior whole-body images.

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View second image(bs). Oblique and lateral chest images.

View third image(ct). CT of the chest.

Full history/Diagnosis is available below

Diagnosis: Poorly differentiated infiltrating ductal breast carcinoma with metaplastic changes.

Full history:

61-year old woman with a history of breast cancer diagnosed four years previously. The patient refused surgery at that time and she presents currently with a large fungating mass involving the right breast. The tumor is adherent to the chest wall. In addition, the patient was in a motor vehicle accident two years previously at which time she sustained multiple pelvic fractures.


Tc-99m MDP


A large focal area of intensely increased uptake is identified in the right breast. This corresponds to the known fungating partially calcified tumor mass. The tumor on bone scintigraphy consists of a large mass with two small satellite components seen anteriorly. Chest radiograph and CT confirmed the presence of calcification within the large breast mass.

Areas of increased activity also are identified in the left parietal bone, the left scapula, and the mid shafts of both femora, consistent with metastatic lesions. Several areas of increased uptake also are identified in the pelvis, which correlated with sites of previous fractures identified on radiographs.


This case is presented for the remarkable breast uptake. Commonly, mild breast uptake is a nonspecific finding and may be seen in the normal female patient as well as in patients with breast carcinoma, mastitis, fibrocystic disease, or trauma. In the male patient, breast activity is usually associated with gynecomastia. In this example, the high intensity of uptake is suggestive of a mass with marked dystrophic calcification or with active bone-forming elements (such as an osteogenic sarcoma). Core biopsy of this patient's mass demonstrated poorly differentiated infiltrating ductal carcinoma with areas of sarcomatous degeneration.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Breast, Category:Neoplasm, Neoplastic-like condition)

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Case number: bs055

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