Breast carcinoma with liver metastasis

Case contributed by Jini P Abraham

Presentation

Known hypertensive, on treatment. History of abdominal distension associated with pain for two weeks. History of significant weight loss.

Patient Data

Age: 70 years
Gender: Female

Heterogeneously enhancing large solid mass lesion involving entire right and caudate lobes of the liver with dystrophic calcifications and necrosis within, infiltrating the intrahepatic segment of inferior vena cava and right portal vein, extending into the left portal vein and main portal vein.

The gallbladder and right adrenal gland are not separately visualized.

Minimal ascites noted.

Enhancing lytic soft tissue lesion noted in left iliac bone.

Incidentally, visualized chest showed an enhancing lobulated soft tissue density lesion with central calcifications in the right breast.

A diagnosis of primary breast malignancy with liver and iliac bone metastases was suggested.

Nuclear medicine

8F-FDG Whole Body PET-CT

Metabolically active disease in the well-defined soft tissue density lesion in the outer quadrant of the right breast – site of the primary lesion.

Lung nodules showing faint metabolic activity – likely to be metastatic.

Low grade metabolic activity noted in large lesion involving the right lobe and the caudate lobe of the liver, showing calcifications within, with exophytic component and infiltration into the intrahepatic segment of inferior vena cava, right, left, and main portal vein – likely to be metastatic.

Hypermetabolic lytic lesion in left iliac bone – metastatic.

Biopsy was performed from the breast and liver lesions under ultrasound guidance.

Biopsy from the upper outer quadrant of the right breast: Infiltrating ductal carcinoma – NOS; triple positive (ER/PR/HER-2 positive).

Biopsy from right lobe liver mass: metastatic carcinoma of breast origin.

Case Discussion

Due to the prevalence of ultrasonography and mammography, the diagnosis of breast carcinoma can be made at the earliest, thereby decreasing its mortality rate. However, there are cases where patients present in the later stage with lung, bone, brain, or liver metastases, which require further evaluation. Metastatic disease to the liver from breast carcinoma is a known site, which can be hypovascular or hypervascular masses. Cross-sectional imaging, including CT, MRI, and PET-CT, is helpful in diagnosing and staging the disease process.

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