|Year : 2016 | Volume
| 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|
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
Source of Support: None, Conflict of Interest: None
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.  Women with a genetic predisposition to breast cancer may be over represented among pregnant women with cancer, although the available evidence is limited.  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.  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.  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.  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. ,, Hicks et al.  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. , 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.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Antonelli NM, Dotters DJ, Katz VL, Kuller JA. Cancer in pregnancy: A review of the literature. Part I. Obstet Gynecol Surv 1996;51:125-34.
Wallack MK, Wolf JA Jr, Bedwinek J, Denes AE, Glasgow G, Kumar B, et al.
Gestational carcinoma of the female breast. Curr Probl Cancer 1983;7:1-58.
Crowe JP Jr, Adler LP, Shenk RR, Sunshine J. Positron emission tomography and breast masses: Comparison with clinical, mammographic, and pathological findings. Ann Surg Oncol 1994;1:132-40.
Yasuda S, Fujii H, Takahashi W, Takagi S, Ide M, Shohtsu A. Lactating breast exhibiting high F-18 FDG uptake. Clin Nucl Med 1998;23:767-8.
Bakheet SM, Powe J, Kandil A, Ezzat A, Rostom A, Amartey J. F-18 FDG uptake in breast infection and inflammation. Clin Nucl Med 2000;25:100-3.
Dankerl A, Schirrmeister H, Buck A, Reske SN. Elevated FDG uptake in the lactating human breast. Clin Nucl Med 2001;26:577-8.
Hicks RJ, Binns D, Stabin MG. Pattern of uptake and excretion of (18)F-FDG in the lactating breast. J Nucl Med 2001;42: 1238-42.
Shor M, Dave N, Reddy M, Ali A. Asymmetric FDG uptake in a lactating breast. Clin Nucl Med 2002;27:536.
Abhyankar A, Joshi J, Basu S. FDG uptake in unilateral breast related to breastfeeding practice in a patient of pulmonary hydatid cyst. Clin Nucl Med 2012;37:676-8.