Image findings of rare case of gestational breast cancer diagnosed in a lactating women with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography

Koramadai Karuppusamy Kamaleshwaran; Sudhakar Natarajan; Firoz Rajan; Vyshak Mohanan; Ajit Sugunan Shinto

doi:10.4103/0971-9903.178110

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CASE REPORT

Year : 2016 | Volume : 21 | Issue : 1 | Page : 63-64

Image findings of rare case of gestational breast cancer diagnosed in a lactating women with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography

Koramadai Karuppusamy Kamaleshwaran¹, Sudhakar Natarajan², Firoz Rajan², Vyshak Mohanan¹, Ajit Sugunan Shinto¹
¹ Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
² Department of Oncology, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India

Date of Web Publication

4-Mar-2016

Correspondence Address:
Koramadai Karuppusamy Kamaleshwaran
Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore - 641 014, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0971-9903.178110

Abstract

Gestational or pregnancy-associated breast cancer is defined as breast cancer that is diagnosed during pregnancy, in the first postpartum year, or any time during lactation. We report rare imaging findings of a breast cancer seen on fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) study in a 32-year-old lactating woman. The FDG PET/CT study demonstrated uptake in the soft tissue lesion noted in the right breast corresponding to primary lesion and multiple nodes in bilateral axilla, right supraclavicular and mediastinum. In addition, there was FDG tracer uptake in both the breast parenchyma-related to breast feeding. This case illustrates the first case of breast cancer in a lactating woman detected by FDG PET/CT.

Keywords: Fluorodeoxyglucose-positron emission tomography/computed tomography, gestational breast cancer, lactating breast uptake, staging

How to cite this article:
Kamaleshwaran KK, Natarajan S, Rajan F, Mohanan V, Shinto AS. Image findings of rare case of gestational breast cancer diagnosed in a lactating women with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography. J Mahatma Gandhi Inst Med Sci 2016;21:63-4

How to cite this URL:
Kamaleshwaran KK, Natarajan S, Rajan F, Mohanan V, Shinto AS. Image findings of rare case of gestational breast cancer diagnosed in a lactating women with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography. J Mahatma Gandhi Inst Med Sci [serial online] 2016 [cited 2023 Mar 30];21:63-4. Available from: https://www.jmgims.co.in/text.asp?2016/21/1/63/178110

Introduction

The incidence of pregnancy associated breast cancer (for the prenatal to postpartum period) is approximately 15-35/100,000 deliveries, with fewer breast cancer cases diagnosed during pregnancy than during the first postpartum year. ^[1] Women with a genetic predisposition to breast cancer may be over represented among pregnant women with cancer, although the available evidence is limited. ^[2] There are no previous reports of F-18 fluorodeoxyglucose-positron emission tomography/computed (FDG PET/CT) in lactating women with breast cancer.

Case Report

A 32-year-old female patient who had delivered a child 2 months back and breast feeding presented with lump in the right breast. She underwent an excision biopsy of the breast lump which showed invasive ductal carcinoma. As a part of evaluation, she was subjected to a PET/CT scan which was done on a hybrid scanner after injection of approximately 10 mCi of F-18 FDG. Maximum intensity projection image [Figure 1], right down] showed diffusely increased FDG uptake in both the breasts due to lactation and intense FDG uptake noted in right breast mass lesion. CT, fused PET/CT and PET transaxial image [Figure 1], right and left] at the level of breast shows increased FDG uptake in bilateral breast parenchyma and multiple nodes. As PET/CT scan confirmed metastatic involvement of multiple nodes, patient underwent chemotherapy.

Figure 1: Whole body fluorodeoxyglucose-positron emission tomography/ computed tomography (FDG PET/CT) maximum intensity projection image, axial CT, PET, fused PET/CT showed an intense uptake in the soft tissue lesion in the right breast. Also bilateral breast parenchyma uptake due to lactation noted

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Discussion

Breast cancer is one of the most common cancers in nonpregnant and pregnant women. ^[1] Up to 20% of breast cancers in women under age 30 are pregnancy-associated, but fewer than 5% of breast cancers diagnosed in women under age 50 are detected during pregnancy or in the postpartum period. ^[2] FDG PET/CT in breast cancer imaging has an adjunctive role in the detection of loco-regional recurrence or distant metastases in locally advanced breast cancer when results of other standard imaging techniques are equivocal or suspicious. ^[3] Increased FDG uptake in lactation is thought to be the result of uptake of plasma glucose for milk production and increased activity of the ductal muscles. ^[4],[5],[6] Hicks et al. ^[7] described that most of patients who were breast-feeding an infant before PET scanning had diffuse and symmetric uptake in the breasts. Asymmetric breast uptake in lactating women and in a patient with hydatid cyst has been described. ^[8],[9] To the best of our knowledge, this is the first case report of breast cancer with lactating breast uptake detected on FDG PET scan. FDG uptake pattern have been useful in predicting the benign or malignant nature of nodes. In our case, as PET study revealed multiple nodal metastases, patient was subjected to chemotherapy. Our case, thus, illustrates that FDG PET/CT is an important imaging modality for the detection and accurate staging and restaging of breast cancer, and to decide upon appropriate treatment even in a lactating women.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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