Case Author(s): John R. Leahy, M.D. and Mark A. Mintun, M.D. , 09/13/98 . Rating: #D2, #Q3

Diagnosis: Inflammatory carcinoma of the right breast.

Brief history:

39 year old woman with enlarged right breast.

Images:

Dual intensity whole body images.

View main image(bs) in a separate image viewer

View second image(bs). Delayed spot images.

View third image(ct). Computed tomography axial images at the level of the breast.

Full history/Diagnosis is available below

Diagnosis: Inflammatory carcinoma of the right breast.

Full history:

39 year old woman presented with right breast swelling. Skin biopsy showed infiltrating ductal carcinoma. The woman was then referred for a staging evaluation with bone scintigraphy.

Radiopharmaceutical:

21.8 mCi Tc-99m MDP i.v.

Findings:

Bone scintigram: Diffuse uptake is seen in the right breast, which is markedly enlarged. No osseous metastases are seen.

CT: Diffuse soft tissue infiltration is seen in the fatty tissue of the right breast.

Discussion:

Bone tracers concentrate in many organs and soft tissues. They have been shown to accumulate at sites of radiographically evident or occult soft tissue calcification and ossification in a manner similar to uptake in osseous structures. Localization in non-calcified soft tissue may be the result of binding to immature collagen or to phosphatase enzymes. In sites of inflammation, activity on delayed views may be the result of increased blood pool activity with impaired washout. In this case, either mastitis or inflammatory carcinoma were felt to be consistent with the findings. Lymphedema might also have been considered if the woman had already undergone axillary lymph node dissection. Distribution of activity was felt to be too extensive for trauma, but too uniform for metastatic calcification. The patient was not pregnant nor on exogenous steroids, both of which can result in increased breast activity (usually bilateral).

References:

Wagner HN, Szabo Z, Buchanan JW: Principles of Nuclear Medicine, 2nd ed. Philadelphia, W.B.Saunders Company 1995; 1008-1009.

Harbert JC, Eckelman WC, Neumann RD: Nuclear Medicine Diagnosis and Therapy. New York, Thieme Medical Publishers, Inc 1996; 837

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: bs095

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