PMC6592707_01
Left mammography showing a dense mammary pattern, with a heterogeneous spiculated dense mass located in the LIQ. BIRADS-5. Two clips marking the lesion prior to neoadjuvant treatment. (A) Craniocaudal and (B) mediolateral oblique view.
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figure1
The patient was studied with mammography [Figure 1] and breast ultrasound [Figure 2], which showed a spiculated mass of 29 x 24 x 14 mm at the LIQ of left breast, with the increased flow at doppler, diagnosed as BIRADS-5.
Ultrasonic left breast showing a hypoechogenic-spiculated mass with the acoustic shadow of 29 x 24 x 14 mm3 in correspondence with the mammographic image.
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figure2
The patient was studied with mammography [Figure 1] and breast ultrasound [Figure 2], which showed a spiculated mass of 29 x 24 x 14 mm at the LIQ of left breast, with the increased flow at doppler, diagnosed as BIRADS-5.
Staging image study. (A) Axial view of PET/CT showing a hypermetabolic left breast nodule of 18 mm at the LIQ, compatible with primary neoplasia. (B) Axial and (C) sagittal views of PET/CT demonstrating extensive substitutive hypermetabolic sternal compromise with cortical osteolysis (maximum SUV 7.7).
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figure3
The staging study demonstrated an osteolytic lesion compatible with sternal metastasis evident in computed tomography (CT), positron emission tomography (PET)/CT and magnetic resonance imaging (MRI) [Figure 3].
Re-staging imaging study, after 6 months of ST. (A) Axial view of PET/CT with size decrease and hypermetabolism resolution at the left breast nodule. (B) Axial and (C) sagittal views of PET/CT showing hypermetabolism resolution at the sternal body lesion.
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figure4
The patient completed neoadjuvant ST with Doxorubicin, Cyclophosphamide, Paclitaxel, and HER2-directed therapy with Trastuzumab and Pertuzumab, with a complete clinical response at physical exam and images [Figure 4].