PMC9992788_01
No abnormal activity was observed in the 18F-FDG MIP image (A). Enlarged lymph nodes were found at bilateral axillary and right inguinal region with mild FDG avidity (SUVmax, 2.1) on 18F-FDG PET/CT (B-D fused PET/CT; white arrows) and no abnormality was seen in the bilateral breasts. In the 68Ga-DOTATATE MIP image (E) and the axial images (F-H fused PET/CT), higher 68Ga-DOTATATE uptake than 18F-FDG was observed in the enlarged bilateral axillary and right inguinal lymph nodes (SUVmax, 8.4; white arrows), and bilateral breasts were still negative.
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Then 18F-FDG PET/CT was performed for an unknown primary origin ( Figure 1 ) and no abnormal activity was observed in the MIP image. Then the patient underwent 68Ga-DOTATATE PET/CT one day after 18F-FDG PET/CT ( Figure 1 ).
A foci of increased 68Ga-DOTATATE activity (A, fused PET/CT) was located in the uterus (SUVmax,11.0; white arrows), but neither notable CT structural alterations nor 18F-FDG activity was seen (B, CT; C, fused PET/CT). This lesion was found to be uterine fibroids after ultrasound examination (D, transabdominal ultrasonography; E, transvaginal ultrasonography).
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MIP image and the axial images, higher uptake of 68Ga-DOTATATE than 18F-FDG was observed in the enlarged bilateral axillary and right inguinal lymph nodes, but bilateral breasts were still negative. Moreover, a lesion with increased 68Ga-DOTATATE activity was located in the uterus with, but neither notable CT structural alterations nor 18F-FDG activity can be seen ( Figure 2 ).
Ultrasound-guided percutaneous biopsy for the 68Ga-DOTATATE-avid left axilla and right inguinal lymph nodes. The pathological results revealed metastatic invasive lobular breast carcinoma (A, left axillary lymph node, HEx200; B, right inguinal lymph node, HEx200). The rectal polyp confirmed metastatic carcinoma of suspected breast origin (C, rectum polyp, HEx200).
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Due to unknown primary origin, this patient underwent ultrasound-guided percutaneous biopsy for the 68Ga-DOTATATE-avid left axilla and right inguinal lymph nodes, and the pathological results revealed metastatic invasive lobular breast carcinoma ( Figure 3 ).