Presentation
Breast cancer on axillary lymph node biopsy. Had polyacrylamide hydrogel injection for breast augmentation almost 30 years earlier.
Patient Data
Brain: no pathological FDG uptake.
Neck: FDG uptake in multinodular goiter.
Chest: uptake in the breasts, most probably secondary to polyacrylamide hydrogel (PAAG) injection, with coarse calcifications and cystic changes. Low-intensity uptake in several left axillary lymph nodes up to 6 mm in small axis diameter. Nonspecific pulmonary nodules, e.g. 3 mm in RML. The lungs are actually clear. No mediastinal or hilar adenopathy. No pleural or pericardial effusion.
Abdomen-pelvis: focal uptake in 1.2 cm rectosigmoid junction soft tissue thickening . The liver is of normal size and texture, with several hypodense foci, e.g. 1.1 cm in segment 2.
Bones: FDG uptake in what appears as traumatic finding in posterior aspect of 10th right rib.
Summary: FDG uptake in breasts in context of post PAAG injection - difficult to discern malignancy from inflammatory process. Moderate intensity uptake in two left axillary lymph nodes.
Bilateral (only left breast shown here):
Breast full of partially calcified blobs.
Bilateral breast tissue is infiltrated extensively by PAA masses intermixed with fluid. In both breasts, some of the masses are surrounded by enhancement, possibly reactive; more prominent on left.
Case Discussion
Pathological left axillary lymph node - intraductal carcinoma (IDC) on biopsy; ER highly positive (+3), PR negative, HER2 highly positive (+3).
The patient elected to have bilateral mastectomy.
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