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LETTER TO EDITOR
Year : 2013  |  Volume : 28  |  Issue : 3  |  Page : 190-191  

Widespread subcutaneous metastases in a patient with breast cancer: Evaluation with fluoro deoxy-glucose positron emission tomography-computed tomography


Department of Nuclear Medicine,Positron Emission Tomography Computed Tomography and Therapy,Amala Institute of Medical Sciences, Thrissur, Kerala, India

Date of Web Publication9-Oct-2013

Correspondence Address:
Chidambaram Natrajan Balasubramanian Harisankar
Department of Nuclear Medicine, Amala Institute of Medical Sciences, Amalanagar, Thrissur 680 555
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.119528

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How to cite this article:
Harisankar CN. Widespread subcutaneous metastases in a patient with breast cancer: Evaluation with fluoro deoxy-glucose positron emission tomography-computed tomography . Indian J Nucl Med 2013;28:190-1

How to cite this URL:
Harisankar CN. Widespread subcutaneous metastases in a patient with breast cancer: Evaluation with fluoro deoxy-glucose positron emission tomography-computed tomography . Indian J Nucl Med [serial online] 2013 [cited 2019 Oct 21];28:190-1. Available from: http://www.ijnm.in/text.asp?2013/28/3/190/119528

Sir,

A 47-year-old female a known case of breast cancer who was previously treated with surgery, chemotherapy and radiation for breast cancer (pT2N0M0 at the time of initial surgery) presented with multiple tiny nodular lesions in the abdominal wall and in the parotid regions. The lesions measured approximately 5 mm in size and were non-tender. Excision biopsy of one of the lesions confirmed metastatic carcinoma with histological features of breast cancer. A whole body 18 fluoride - fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) [Figure 1] was ordered to evaluate the extent of disease. FDG PET-CT was performed 75 min after intravenous injection of 300 MBq of FDG [Figure 1]. The study revealed extensive FDG avid nodular lesions throughout the subcutaneous tissue the body. All the lesions were less than 1 cm in size. In addition, FDG PET-CT identified multiple lung nodules and bone marrow lesions indicating metastases. The patient is being treated with chemotherapy.
Figure 1: Maximum intensity projection image (a) of the whole body positron emission tomography-computed tomography (WB PET-CT), Coronal WB CT (b), Coronal WB PET. (c) and serial coronal slices of PET (d) reveale extensive FDG avid nodular lesions throughout the subcutaneous tissue the body. In addition, multiple lesions are also noted in the entire bone marrow. A few FDG avid lung nodules were also noted

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Cutaneous metastases from internal malignancies account for 0.7% and 9% of all metastases. [1] It may be the first symptom in 7% of the patients with cancer. [1] Among all malignancies, the highest incidence of cutaneous metastasis is seen in breast cancer. [1] Cutaneous metastases have been previously described from gall bladder carcinoma, [2] pancreas, [3] colorectal cancer, [4] uterine leiomyosarcoma, [5] renal cell carcinoma. [6] Utility of FDG PET/CT in identifying and evaluating cutaneous and subcutaneous metastases have been previously described. [4],[7],[8],[9],[10] Though cutaneous metastases may be the presenting symptom it usually represents advanced disease and poor prognosis. FDG PET-CT can potentially be used as a one-stop-shop imaging modality in patients with cutaneous/subcutaneous metastases from FDG avid primary malignancies. FDG PET-CT may also find a role in evaluating the response of these lesions to treatment.

 
   References Top

1.Lookingbill DP, Spangler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: A retrospective study of 4020 patients. J Am Acad Dermatol 1993;29:228-36.  Back to cited text no. 1
    
2.Garg PK, Khurana N, Hadke NS. Subcutaneous and breast metastasis from asymptomatic gallbladder carcinoma. Hepatobiliary Pancreat Dis Int 2009;8:209-11.  Back to cited text no. 2
    
3.Horino K, Takamori H, Ikuta Y, Nakahara O, Chikamoto A, Ishiko T, et al. Cutaneous metastases secondary to pancreatic cancer. World J Gastrointest Oncol 2012;4:176-80.  Back to cited text no. 3
    
4.Karyagar S, Karyagar SS, Kece C, Ozdil B. Subcutaneous metastases of colorectal cancer detected with PET/CT. Clin Nucl Med 2010;35:267-8.  Back to cited text no. 4
    
5.Corcoran S, Hogan AM, Nemeth T, Bennani F, Sullivan FJ, Khan W, et al. Isolated cutaneous metastasis of uterine leiomyosarcoma: Case report and review of literature. Diagn Pathol 2012;7:85.  Back to cited text no. 5
    
6.Koga S, Tsuda S, Nishikido M, Matsuya F, Saito Y, Kanetake H. Renal cell carcinoma metastatic to the skin. Anticancer Res 2000;20:1939-40.  Back to cited text no. 6
    
7.Borkar S, Pandit-Taskar N. F-18 FDG uptake in cutaneous metastases from breast cancer. Clin Nucl Med 2008;33:488-9.  Back to cited text no. 7
    
8.Hyun IY, Yun MY. FDG uptake in cutaneous and subcutaneous metastases from colorectal adenocarcinoma. Clin Nucl Med 2010;35:93-4.  Back to cited text no. 8
    
9.Manohar K, Mittal BR, Bhattacharya A, Singh G. Asymptomatic distant subcutaneous metastases detected by (18) F-FDG-PET/CT in a patient with breast carcinoma. World J Nucl Med 2012;11:24-5.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.Nguyen VX, Nguyen BD, Ram PC. Occult colon cancer with initial cutaneous metastatic manifestation: PET/CT detection. Clin Nucl Med 2012;37:506-8.  Back to cited text no. 10
    


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