Let’s have an interest of extramammary findings on pre operative breast MRI

Congress:

ECR 2018

Poster Number:

C-1335

Type:

Educational Exhibit

Keywords:

Breast, MR, Biopsy, Cancer

Authors:

H. W. Yoo, S. Y. Kim, S. Huh; Cheonan/KR

DOI:

10.1594/ecr2018/C-1335

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-1335

Fig. 4: Case 3. 43-year-old woman who have IDC in right breast. (A) CE T1-weighted-MRI...

Fig. 5: Case 4. 63-year-old woman who have IDC in both breast. (A,B) CE...

Fig. 6: Case 5. 74-year-old woman who have DCIS in right breast. (A) CE...

Fig. 7: Case 6. 54-year-old woman who have IDC in left breast. (A) CE T1-weighted-MRI...

Fig. 8: Case 7. 62-year-old woman who have IDC in left breast. (A) CE T1-weighted-MRI...

Fig. 9: Case 8. 64-year-old woman who have IDC in right breast. (A) CE T1-weighted-MRI...

Fig. 10: Case 9. 50-year-old woman who have IDC in right breast. (A) CE T1-weighted-MRI...

Fig. 11: Case 10. 79-year-old woman who have IDC in right breast. (A) CE...

Fig. 12: Case 11. 78-year-old woman who have invasive lobular carcinoma in right...

Fig. 13: Case 12. 41-year-old woman who have IDC in left breast. (A) CE T1-weighted-MRI...

Fig. 14: Case 13. 45-year-old woman who underwent excision biopsy for right breast mass,...

$Fig. 15: Case 14. 73-year-old woman who have IDC in right breast. (A) CE T1-weighted-MRI shows 4.2cm extent IDC in right breast with skin invasion(Arrow). (B) CE T1-weighted-MRI shows focal enhancing lesion in right rib, which is suspicious bone metastasis on MRI(Arrow). (C,D) Axial CE CT image also shows multiple rib fracture with callus formation(Arrows). (E) Bone scan also shows multiple rib fracture in both side(Arrows).$

Fig. 15: Case 14. 73-year-old woman who have IDC in right breast. (A) CE...

Fig. 16: Case 15. 35-year-old woman who have IDC in right breast with history of...

Fig. 17: Case 16. 45-year-old woman who have IDC in left beast. (A) CE T1-weighted-MRI...

Fig. 18: Case 17. 45-year-old woman who have IDC in left beast. (A) CE T1-weighted-MRI...

Fig. 19: Case 18. 59-year-old woman who underwent modified radical mastectomy due to...

Findings and procedure details

Part 1. Extramammatry findings in thorax - Benign

Thymoma

Case 1. 56-year-old woman who have IDC in right breast. (Fig. 2)

Fig. 2: Case 1. 56-year-old woman who have IDC in right breast. (A) CE T1-weighted-MRI shows 1.4cm size IDC in right breast(Arrow). (B,C) CE T1-weighted-MRI shows enhancing mass in anterior mediastinum(Yellow arrow). In axial chest CT, there is enhancing nodule at the same location as the MRI(Red arrow). (D) PET-CT shows round shape mass with FDG uptake(MaxSUV 2.3) in same location as the MRI(Arrow). The mass was proven thymoma after excision and biopsy.

Thymic cyst

Case 2. 48-year-old woman who have DCIS in left breast. (Fig. 3)

Fig. 3: Case 2. 48-year-old woman who have DCIS in left breast (A) CE T1-weighted-MRI shows 1.2cm size DCIS in left breast(Arrow). (B,C) CE T1-weighted-MRI shows 1.3cm size non enhancing nodule in anterior mediastinum(Yellow arrow). In axial chest CT, there is low attenuated non-enhancing nodule at the same location as the MRI(Yellow arrow). (D) PET-CT shows round shape nodule with no FDG uptake in same location as the MRI(Arrow).

Tuberculosis sequelae

Case 3. 43-year-old woman who have IDC in right breast. (Fig. 4)

Fig. 4: Case 3. 43-year-old woman who have IDC in right breast. (A) CE T1-weighted-MRI shows 1.5cm size IDC in right breast(Arrow). (B) T1-weighted-MRI shows irregular mass in right upper lobe. (Yellow arrow). (C,D) In pre contrast axial chest CT , there is calcific nodule at the same location as the MRI(Yellow arrow). Also, in lung window setting, there is band like opacity around the calcific nodule (Yellow arrow). Considering patient history and radiologic findings, it was presumed tuberculosis sequelae.

Atelectasis mimicking pleural metastasis

Case 4. 63-year-old woman who have IDC in both breast. (Fig. 5)

Fig. 5: Case 4. 63-year-old woman who have IDC in both breast. (A,B) CE T1-weighted-MRI shows about 1.7cm and 1cm IDC in both breasts(Arrows). (C,D) CE T1-weighted-MRI shows about 1.3cm size enhancing lesion in right superior diaphragmatic area, which mimicking pleural metastasis on MRI. However, this lesion is correlated with RML atelectasis on axial chest CT(Arrows).

Aberrant right subclavian artery

Case 5. 74-year-old woman who have DCIS in right breast. (Fig. 6)

Fig. 6: Case 5. 74-year-old woman who have DCIS in right breast. (A) CE T1-weighted-MRI shows 1cm size DCIS in right breast(Arrow). (B) T1 -weighted-MRI show vascular structure(Yellow arrow) arising from the aortic arch after left subclavian artery running posterior to esophagus. (C,D,E) In serial axial and reformatted coronal chest CT, there is abberant right subclavian artery (Yellow arrow)running posterior aspect to esophagus (empty arrow).

Pneumonia

Case 6. 54-year-old woman who have IDC in left breast. (Fig. 7)

Fig. 7: Case 6. 54-year-old woman who have IDC in left breast. (A) CE T1-weighted-MRI shows IDC in left breast(Arrow). (B) CE T1-weighted-MRI shows 2.5cm extent nonenhancing mass in Lt. lung parenchyme. (C,D) Axial chest CT, there is consolidation and GGO in LLL superior segment. Patient showed elevated WBC and treated with antibiotics.

Part 2. Extramammary findings in thorax - Malignant

Lung metastasis

Case 7. 62-year-old woman who have IDC in left breast. (Fig. 8)

Fig. 8: Case 7. 62-year-old woman who have IDC in left breast. (A) CE T1-weighted-MRI shows 3.7cm IDC in Lt. upper center(Arrow). (B) Follow up breast MRI one year after surgery, there is 1.6cm size enhancing nodule in right lung(Arrow). (C) Axial chest CT also shows enhancing nodule in RML(Arrow). It was proven metastatic cancer by PTNB. (D) PET-CT shows increased FDG uptake(MaxSUV 8.43) in right lung(Arrow).

Internal mammary lymph node metastasis

Case 8. 64-year-old woman who have IDC in right breast. (Fig. 9)

Fig. 9: Case 8. 64-year-old woman who have IDC in right breast. (A) CE T1-weighted-MRI shows 3.3cm size IDC in left breast(Arrow). (B) CE T1-weighted-MRI shows 7mm size enhancing nodule in left internal mammary chain. (Yellow arrow). (C) In CE axial chest CT , there is enhancing nodule nodule at the same location as the MRI(Yellow arrow) The nodule was proven metastatic lymph node after operation.

Pleural metastasis

Case 9. 50-year-old woman who have IDC in right breast. (Fig. 10)

Fig. 10: Case 9. 50-year-old woman who have IDC in right breast. (A) CE T1-weighted-MRI shows about 7cm size IDC with skin invasion(Arrow). (B) CE T1-weighted-MRI shows small enhancing nodule on left anterior pleural surface(Arrow). (C, D) Axial CE CT image shows multiple pleural metastases(Arrows).

Part 3. Extrammary findings in upper abdomen – benign

Hepatic cyst

Case 10. 79-year-old woman who have IDC in right breast. (Fig. 11)

Fig. 11: Case 10. 79-year-old woman who have IDC in right breast. (A) CE T1-weighted-MRI shows 3.1cm size IDC in left breast(Arrow). (B) T1-weighted-MRI shows 5.7cm size low SI lesion in Lt. lateral segment of liver. (Yellow arrow). (C) CE axial CT, there is non enhancing low attenuated lesion at the same location as the MRI(Yellow arrow) (D) On USG, there is anechoic lesion with posterior acoustic enhancement in left lateral segment of liver.

Hiatus hernia

Case 11. 78-year-old woman who have invasive lobular carcinoma in right breast. (Fig. 12)

Fig. 12: Case 11. 78-year-old woman who have invasive lobular carcinoma in right breast. (A) CE T1-weighted-MRI shows 2.4cm size ILC in right breast(Arrow). (B) T1-weighted-MRI shows low SI mass like lesion in 5.7cm size low SI lesion in para-esophageal area (Yellow arrow). (C,D) CE axial and coronal reformatted CT, there herniation of abdominal contents thorugh esophageal hiatus. (Yellow arrow)

Liver cirrhosis and ascites

Case 12. 41-year-old woman who have IDC in left breast. (Fig. 13)

Fig. 13: Case 12. 41-year-old woman who have IDC in left breast. (A) CE T1-weighted-MRI shows 5.2cm IDC in left breast(Arrow). (B) CE T1-weighted-MRI shows nodular contour of liver(Red arrows) and ascites(Yellow arrows), which suggests liver cirrhosis. (C) Axial CE CT image also shows nodular contour of liver and ascites, which is well correlated with previous breast MRI.

Part 4. Extramammary findings in upper abdomen – Malignant

Hepatic metastasis

Case 13. 45-year-old woman who underwent excision biopsy for right breast mass, which was proven IDC. (Fig. 14)

Fig. 14: Case 13. 45-year-old woman who underwent excision biopsy for right breast mass, which was proven IDC. (A) CE T1-weighted-MRI shows about 2.5 cm post-op hematoma in right breast(Arrow). (B) CE T1-weighted-MRI shows multiple ill-defined hypointense nodules in liver(Arrows). (C) Axial CT image shows correlating multiple ill-defined lesions in the liver, which suggests liver metastasis (D) PET-CT shows diffuse and heterogenous FDG uptake along both lobes of liver.

Part 5. Extramammary findings in bone and soft tissue – benign

Rib fracture mimicking bone metastasis

Case 14. 73-year-old woman who have IDC in right breast. (Fig. 15)

Fig. 15: Case 14. 73-year-old woman who have IDC in right breast. (A) CE T1-weighted-MRI shows 4.2cm extent IDC in right breast with skin invasion(Arrow). (B) CE T1-weighted-MRI shows focal enhancing lesion in right rib, which is suspicious bone metastasis on MRI(Arrow). (C,D) Axial CE CT image also shows multiple rib fracture with callus formation(Arrows). (E) Bone scan also shows multiple rib fracture in both side(Arrows).

Pectus excavatum

Case 15. 45-year-old woman who have IDC in left breast. (Fig.16)

Fig. 17: Case 16. 45-year-old woman who have IDC in left beast. (A) CE T1-weighted-MRI shows 7cm size IDC with skin invasion in left breast(Arrow). (B) CE T1-weighted-MRI shows concave depression of sternum and chest wall deformity.(Yellow arrow). (C) CE CT, Haller index is calculated as 3.06, compatible with pectus excavatum.

Neurofibromatosis

Case 16. 35-year-old woman who have IDC in right breast with history of neurofibromatosis (Fig. 17)

Fig. 16: Case 15. 35-year-old woman who have IDC in right breast with history of neurofibromatosis (A) CE T1-weighted-MRI shows 7cm size IDC with in left breast (B) T1-weighted-MRI shows 1.6cm size nodule in Lt. lateral chest wall. (Yellow arrow). (C,D) CE T1-weighted-MRI shows several small nodules in subcutaneous layer. (E,F) CE axial CT, there is 2.4cm size hardly enhancing nodule in paraaortic area and small nodule in soft tissue.

Part 6. Extramammary findings in bone and soft tissue – malignant

Pectoralis muscle metastasis

Case 17. 45-year-old woman who have IDC in left beast. (Fig. 18)

Fig. 18: Case 17. 45-year-old woman who have IDC in left beast. (A) CE T1-weighted-MRI shows multiple IDCs with skin invasion in left breast(Arrow). (B) CE T1-weighted-MRI shows enlargement of pectoralis muscle with enhancement.(Yellow arrow). (C) CE axial CT, there is metastasis in left pectoralis muscle and skin invasion. (D) PET-CT shows increased FDG uptake in left pectoralis muscle, which is suggestive of metastasis

Bone metastasis

Case 18. 59-year-old woman who underwent modified radical mastectomy due to left breast mucinous cancer 14 years ago.(Fig. 19)

Fig. 19: Case 18. 59-year-old woman who underwent modified radical mastectomy due to left breast mucinous cancer 14 years ago. (A,B) CE T1-weighted-MRI shows enhancing lesions in sternum, and left scapula(Arrows). (C) Wholebody bone scan shows multiple uptakes in C-T-L-S spines, both pelvic bone, both ribs, left scapula, and left clavicle(Arrows). (D,E) PET-CT shows multiple FDG uptake in sternum, left rib and scapula(Arrows).