Extensive metastases - breast carcinoma

Case contributed by Avni K P Skandhan
Diagnosis almost certain


Patient presented with lower back ache. On examination she had a palpable liver for which she was advised an ultrasound, which picked up focal liver lesions.

Patient Data

Age: 60 years
Gender: Female

Known case of carcinoma breast, status post mastectomy and radiotherapy presently having evidence of hepatic, nodal, adrenal, pulmonary, pancreatic, bony and soft tissue metastasis.


Hepatomegaly with multiple, irregular, hetrogenously enhancing lesions with central interspersed areas of non enhancement.

Right adrenal mass lesion. Left adrenal appears normal.

Multiple enlarged peripancreatic, periportal, paraaortic, celiac axis and posterior to crus lymph nodes.


Evidence of left mastectomy.

Multiple focal parenchymal lesions in bilateral lower zones, right paracardiac and right hilar region. The lesions in the right hilar region are causing compression of the inferior lower lobar bronchus. There is collapse of basal segment of the right lower lobe. Heterogeneous area of differential enhancement seen within this collapsed segment probably representing metastatic lesions.

The right diaphragm is at a higher level as compared to the left. There is a small lesion along the course of the right phrenic nerve, possibly causing compression of this branch.

Multiple enlarged mediastinal lymph nodes in the superior mediastinum, anterior mediastinum, upper pre- and paratracheal regions, prevascular and in the right paracardiac region. Minimal right pleural effusion.

Bone and soft tissue:

There are multiple predominant lytic areas in the 7th cervical vertebra, 3rd, 5th, 7th, 9th, 11th and 12th throacic vertebral bodies with involvement of the left transverse process, spinous process of the 7th thoracic vertebra.

There are similar lytic areas seen in the vertebral end of right 7th rib, bodies of 1st, 2nd, 4th and 5th lumbar vertebral bodies, bilateral illiac crests, bilateral pubis and right ischiopubic ramus. There is evidence of healed fractures with callus formation in bilateral 3rd, right 5th and right 9th ribs suggestive of old fractures.

There is significant soft tissue component associated with these lytic areas in the right 3rd rib, costochondral regions of right 2nd, 3rd ribs, the 8th, 12th, 7th and 9th thoracic vertebrae with posterior extension of the soft tissue component causing cord compression in the latter.

There is an enhancing hetrogenous soft tissue lesion in the region of right ischiopubic ramus. This lesion is causing displacement of the right obturator internus and externus. There is mild erosion of the ischiopubic ramus on the same side. There is another smaller similar lesion noted in between right pectineus and obturator externus muscle.

There is evidence of focal hazy enhancement in the right erector spinae muscle – probably involved.

Case Discussion

Breast cancer is one of the commonest malignancies in female population. The most common distant sites of metastasis are liver, bone and lung. Intrathoracic metastasis from breast cancer commonly involves the lungs, pleura, mediastinum, and airway 1. Rarely pancreatic and soft tissue metastasis have been documented 2,3,4.

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