Presentation
Staging for newly diagnosed right breast carcinoma.
Patient Data
Zoomed and cropped image showing the right breast: micro lobulated solid nodule in the right breast, pathologically proven as breast carcinoma.
Axial lung series: multiple randomly distributed ground glass nodules of various sizes, measuring up to 5mm. Some of the nodules have a relatively lucent center.
Zoomed and cropped image showing the right lung base: ground glass nodule with a lucent center, described as the cheerio sign.
PET/CT images showing some of the larger ground glass pulmonary nodules, without FDG avidity. The known right breast carcinoma is FDG avid.
Case Discussion
Multiple randomly distributed ground glass pulmonary nodules are present in both lungs. There were no other potential metastases in the chest or abdomen. The nodules were not FDG avid at PET/CT. The possible differential diagnosis of breast carcinoma metastases was considered and two wedge resections of the left upper lobe was performed for definitive diagnosis.
Histopathology: proliferation of plump spindled cells in the interstitium with bland cytological features. No necrosis or mitoses.
Immunohistochemistry:
OSCAR (epithelial marker): negative
CD56: positive
Synaptophysin and Chromogranin (neuroendocrine markers): negative
EMA: positive
Progesterone receptors: positive
CD1a: negative
Melan A: negative
HMB45: negative
Features were consistent with pulmonary meningothelial nodules.
Radiologic-pathologic correlation: concordant.