Presentation
Left breast pain and skin induration.
Patient Data
A diagnostic mammogram shows a mass in the left breast with surrounding global asymmetry and overlying skin thickening. No calcifications or architectural distortion.
Single phase whole body bone scan obtained 3 hours after the administration of 20 mCi of Tc99m MDP IV.
Whole body images show no evidence of osteoblastic metastases or areas of photopenia to suggest lytic bone lesions. Degenerative uptake is present in the shoulders and ankles. There is a large area of abnormal radiotracer uptake in the left breast related to known inflammatory breast cancer.
An anterior spot view of the chest better shows the left breast uptake.
Contrast-enhanced CT of the chest shows severe skin thickening over the left breast with an underlying mass and ipsilateral axillary adenopathy. The mass and an enlarged axillary lymph node have markers from a recent biopsy.
Pathology confirmed invasive ductal carcinoma with lymphovascular invasion present in multiple quadrants of the breast and metastatic to the axillary lymph nodes. The clinical exam showed peau d'orange skin and nipple retraction. Findings are consistent with inflammatory breast cancer.
Case Discussion
The concentration of radionuclide bone imaging agents in the breast has been described in a variety of both benign and malignant lesions. The mechanism of uptake is poorly understood and may be related to local metabolic conditions (calcium metabolism and pH), inflammatory reaction, deposition of immature collagen, and increased blood pool.
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