PMC10391531_01
Bilateral mammography with nodular images in the left breast.
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The bilateral mammography (Figure 1) highlighted breasts with a mixed density appearance; in the inferior-inner dial of the left breast were two nodular images with a diameter of <12 mm, homogeneously weakly radiopaque; micronodular opacities bilateral axillary. 
CT scan of thorax-abdomen-pelvis: (A) Hepatic tumor at the portal bifurcation; (B) Liver tumor at maximum diameter.
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Bone scan: multiple bone metastases.
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A bone scan (Figure 3) revealed multiple metastases to: left humeral head, right humerus diaphysis, VIIth left and VIth right ribs, toraco-lumbosacral spine, left iliac crest, right pubis, and bilateral femur. 
PET-CT: (A) overall image; (B) liver tumor.
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In September 2019, the patient had a PET-CT examination, which revealed: pulmonary, the apical-posterior segment of the upper left lobe showed a solid nodule with infiltrative contours, metabolically active with SUV = 1.77 and dimensions of 13/9mm; multiple bilateral pulmonary micronodular images located centrally and subpleurally, most with dimensions up to 5mm without increased metabolic activity - secondary determinations; the posterobasal segment of the lower left lobe showed an ovoid nodule with dimensions of 12/11 mm, with increased minimal metabolic activity, SUV = 0.8; metabolically active subaortic adenopathy with SUV = 6.59 and dimensions of 27/17 mm; normal distribution of activity at bilateral breast level; tumor-transformed liver (Figure 4), with multiple metabolically active lesions confluent with portal wash-out and SUV = 11.25; and multiple metabolically active lesions (SUV max. = 8.19), with osteocondensating aspect, visible at the bilateral humeral level, bilateral clavicle, bilateral scapula, sternum, anterior rib arch