PMC5070031_01
A 66-year-old female with neuroendocrine tumor metastasis to the breast detected on mammogram. Screening mammogram craniocaudal (a) and mediolateral oblique (b) views demonstrates a 5 mm partially obscured mass (arrows) in the upper outer left breast.
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F1
The mammogram did not show any abnormal finding in this palpable area; however, the mammogram did show an approximately 6 mm mass in the upper outer quadrant of the left breast [Figure 1].
A 66-year-old female with neuroendocrine tumor metastasis to the breast detected on screening mammogram. Ultrasound of the left breast demonstrates a 5 mm irregular hypoechoic mass (arrows) at 2:00 position, corresponding to mass seen on the screening mammogram.
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F2
Ultrasound demonstrated an irregular hypoechoic mass at 2 O'clock position [Figure 2], corresponding to the abnormality seen on the mammogram.
A 66-year-old female with neuroendocrine tumor metastasis to the breast detected on screening mammogram. Solid area of tumor demonstrates uniform cells with moderate amounts of pink granular cytoplasm and uniform round to oval nuclei (arrows). Tumor cells are supported by delicate fibrovascular cores (x400).
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F3
Histologic sections showed a cellular neoplasm arranged in vague lobules with delicate fibrovascular cores embedded in a fibrous stroma [Figure 3].
A 66-year-old female with neuroendocrine tumor metastasis to the breast detected on screening mammogram. (a) Subtraction postcontrast images of breast magnetic resonance imaging show a 9 mm microlobulated enhancing mass (arrows) at 2:00 position of the left breast corresponding to the biopsy proven metastatic well-differentiated neuroendocrine tumor. (b) An enlarged lymph node (arrows) is present between the left pectoralis major and minor muscles (Rotter's node) consistent with Level II lymphadenopathy.
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F4
MRI was also performed to evaluate the extent of the disease which demonstrated the irregular enhancing mass in the upper outer quadrant of the left breast [Figure 4a], corresponding to the known biopsy proven metastatic neoplasm. MRI identified additional lesions in the liver as well as Level 2 lymphadenopathy seen between the pectoralis major and minor muscles (Rotter's node) [Figure 4b].
A 66-year-old female with neuroendocrine tumor metastasis to the breast detected on screening mammogram. (a) Cross-section images from abdominal computed tomography scan show 2 cm irregular enhancing mass (arrow) at the ileocecal valve with central calcification consistent with primary well-differentiated neuroendocrine tumor. (b) Two hypoenhancing lesions (arrows) were noted in the liver most compatible with metastases.
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F5
Subsequently, the patient underwent to a CT of the abdomen and pelvis which showed at least seven liver lesions, with the largest lesion at segment 4 measuring approximately 2.6 cm [Figure 5b]. There was also a spiculated mass with calcifications in the right lower quadrant near the ileocecal valve concerning for primary ileal WDNET [Figure 5a].
A 66-year-old female with neuroendocrine tumor metastasis to the breast detected on screening mammogram. (a) Fused image of OctreoScan shows intense radiotracer activity in the lymph node (dashed arrow) between the left pectoralis major and minor muscles (Rotter's node), consistent with Level 2 lymphadenopathy and metastatic lesion in the left breast (solid arrow). There is also a focus of increased activity in the distal small bowel (dotted arrow), consistent with primary well-differentiated neuroendocrine tumor. (b) Planar image of OctreoScan reveals foci of increased activity in the liver (dashed arrow) compatible with liver metastases as well as demonstration of increased activity in the distal small bowel (solid arrow), consistent with primary well-differentiated neuroendocrine tumor.
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F6
The patient then underwent OctreoScan [Figure 6] which demonstrated increased uptake in the left axillary Level 2 lymph node, within the breast lesion itself, in the liver lesions, and within the ileal mass consistent with primary ileal WDNET with metastasis to the breast, liver, and axillary lymph node.