|Year : 2017 | Volume
| Issue : 4 | Page : 374-376
Case of carcinoma breast with unusually large tumor thrombus in superior vena cava detected on 18F-fluorodeoxyglucose positron emission tomography computed tomography scan
Arun Sasikumar, Anto Baby, Mathews Jose, Retcy Mary Paul
St. Gregorios International Cancer Care Centre, Pathanamthitta, Kerala, India
|Date of Web Publication||12-Oct-2017|
St. Gregorios International Cancer Care Centre, Parumala, Pathanamthitta - 689 626, Kerala
Source of Support: None, Conflict of Interest: None
| Abstract|| |
A 60-year-old female with triple negative breast cancer, postsurgery, neoadjuvant chemotherapy and radiotherapy, on follow-up had facial puffiness and giddiness. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) done for suspected recurrence evaluation revealed a large tumor thrombus (TT) in superior vena cava (SVC) with radiological evidence of SVC obstruction. 18F-FDG PET/CT also showed evidence of FDG avid brain metastases, lymph nodal metastases, and metastatic soft tissue deposits. This case of unusually large TT in SVC detected on 18F-FDG PET/CT highlights the ability of 18F-FDG PET/CT to identify TT and clearly demonstrate the pattern of disease in suspected recurrence in triple negative breast cancer patients.
Keywords: Carcinoma breast, fluorodeoxyglucose positron emission tomography/computed tomography, superior vena cava, tumor thrombus
|How to cite this article:|
Sasikumar A, Baby A, Jose M, Paul RM. Case of carcinoma breast with unusually large tumor thrombus in superior vena cava detected on 18F-fluorodeoxyglucose positron emission tomography computed tomography scan. Indian J Nucl Med 2017;32:374-6
|How to cite this URL:|
Sasikumar A, Baby A, Jose M, Paul RM. Case of carcinoma breast with unusually large tumor thrombus in superior vena cava detected on 18F-fluorodeoxyglucose positron emission tomography computed tomography scan. Indian J Nucl Med [serial online] 2017 [cited 2021 Mar 5];32:374-6. Available from: https://www.ijnm.in/text.asp?2017/32/4/374/216572
A 60-year-old female diagnosed with carcinoma breast (left) in 2015 underwent a modified radical mastectomy followed by neoadjuvant chemotherapy and radiotherapy. She completed her treatment in early 2016 and was on regular follow-up as she had the triple negative disease (estrogen, progesterone, and Herceptin receptor). She complained of facial puffiness and giddiness. On examination, she was found to have mildly enlarged left supraclavicular lymph nodes. She was referred for 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) scan for recurrence evaluation.18 F-FDG PET/CT showed evidence of right intramammary, mediastinal and bilateral supraclavicular lymph nodal metastases, brain metastases, lung metastasis, and metastatic soft tissue deposits. [Figure 1] shows representative sections of a few of these lesions. In addition,18 F-FDG PET/CT scan also showed evidence of a large filling defect measuring 4.5 cm × 6.6 cm in size in the superior vena cava (SVC) extending from its origin up to the right atrium [Figure 2]. The filling defect was seen extending into the right brachiocephalic vein and the adjoining parts of right jugular vein. An area of heterogeneous contrast enhancement was noted in the medial aspect of the filling defect with intense FDG uptake suggesting it to be a tumor thrombus (TT). Extensive venous collaterals were evident along the right anterior chest and abdominal wall suggestive of SVC obstruction.
|Figure 1: Intensely FDG concentrating brain metastases (yellow arrow a – fused PET/CT, b – CECT) and intensely FDG concentrating intra-abdominal soft tissue deposit in the left hypochondrium (c – fused PET/CT, d – CECT), soft tissue deposit in the left inguinal region (e – fused PET/CT, f – CECT), and in subcutaneous tissue in posterior aspect of left thigh (red arrow, g – fused PET/CT, h – CECT) were also noted. FDG: Fluorodeoxyglucose, PET/CT: Positron emission tomography/computed tomography, CECT: Contrast-enhanced computed|
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|Figure 2: 18F-FDG PET/CT (a – maximum intensity projection) showed multiple abnormal tracer concentrating lesions in the brain, neck, thorax, left upper abdomen, and left thigh. Representative axial sections (b – fused PET/CT, c – contrast-enhanced CT [CECT]) and sagittal sections (d – fused PET/CT, e – CECT) shows a large filling defect measuring 4.5 cm × 6.6 cm in size in the SVC extending from its origin up to the right atrium. FDG: Fluorodeoxyglucose, PET/CT: Positron emission tomography/computed tomography, CECT: Contrast-enhanced computed, SVC: Superior vena cava|
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The role of 18 F-FDG PET/CT in staging, restaging, prognostication, and suspected recurrence evaluation of breast cancer especially triple negative disease is well established.,,, It has been identified that patients with malignancy are at a 4–7-fold higher risk of venous thromboembolism (VTE) than nononcology patients. VTE is not uncommon in breast cancer patients, and it most commonly affects the lower extremities and is more common during the first 6 months after diagnosis. The higher incidence of VTE in the early treatment period may be related to surgical procedures and systemic treatment strategies. However, these are normally bland thrombus, and the incidence of TT is relatively rare. TT is more commonly associated with hepatocellular carcinoma, renal cell carcinoma, and gonadal tumors. Among the sites of TT, most common is inferior vena cava, followed by portal and renal veins. SVC is a relatively rare site of TT although few case reports exist., The ability of 18 F-FDG PET/CT in identifying TT and differentiating it from bland thrombus is studied. This case of unusually large TT in SVC detected on 18 F-FDG PET/CT scan highlights the ability of 18 F-FDG PET/CT scan to identify TT and clearly demonstrate the pattern of disease in suspected recurrence in triple negative breast cancer patients.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ulaner GA, Castillo R, Goldman DA, Wills J, Riedl CC, Pinker-Domenig K, et al.
(18)F-FDG-PET/CT for systemic staging of newly diagnosed triple-negative breast cancer. Eur J Nucl Med Mol Imaging 2016;43:1937-44.
Groheux D, Cochet A, Humbert O, Alberini JL, Hindié E, Mankoff D.18
F-FDG PET/CT for staging and restaging of breast cancer. J Nucl Med 2016;57 Suppl 1:17S-26S.
Grassetto G, Fornasiero A, Otello D, Bonciarelli G, Rossi E, Nashimben O, et al.
18F-FDG-PET/CT in patients with breast cancer and rising Ca 15-3 with negative conventional imaging: A multicentre study. Eur J Radiol 2011;80:828-33.
Yue Y, Cui X, Bose S, Audeh W, Zhang X, Fraass B. Stratifying triple-negative breast cancer prognosis using 18F-FDG-PET/CT imaging. Breast Cancer Res Treat 2015;153:607-16.
Streiff MB. Diagnosis and initial treatment of venous thromboembolism in patients with cancer. J Clin Oncol 2009;27:4889-94.
Rebouças D, Costa M, Thuler L, Garces A, Aquino L, Bines J. Breast cancer-associated venous thromboembolism: A case-control study. Breast 2016;28:84-8.
Aurangabadkar HU, Palle L, Ali Z. Tumour thrombosis and patterns of fluorine-18 fluorodeoxyglucose uptake: A pictorial review. Nucl Med Commun 2013;34:627-37.
Lai P, Bomanji JB, Mahmood S, Nagabhushan N, Syed R, Gacinovic S, et al.
Detection of tumour thrombus by 18F-FDG-PET/CT imaging. Eur J Cancer Prev 2007;16:90-4.
Batra S, Doval DC, Batra U, Suresh P, Dhiman A, Talwar V. Gallbladder cancer with tumor thrombus in the superior vena cava. Hepatobiliary Pancreat Dis Int 2010;9:325-8.
D'Souza MM, Jaimini A, Sharma R Tripathi M, Singh D, Pandey S, et al
. 18F-FDG PET/CT in the diagnosis of tumour thrombus from anaplastic thyroid carcinoma in a young boy. Iran J Nucl Med 2010;18:52-6.
Hu S, Zhang J, Cheng C, Liu Q, Sun G, Zuo C. The role of 18F-FDG PET/CT in differentiating malignant from benign portal vein thrombosis. Abdom Imaging 2014;39:1221-7.
[Figure 1], [Figure 2]