PMC9366166_01
Occult breast cancer accompanied by metastasis in axillary lymph nodes. (A) MRI showing multiple enlarged and fused lymph nodes (arrow). (B) PET/CT showing multiple enlarged nodes on the deep muscles of the left axilla and the left anterior upper chest wall, radioactively concentrated (arrow) as well as with no evident metabolically active lesion in the bilateral breasts, remaining trunk, and brain.
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Dynamic contrast-enhanced magnetic resonance imaging (Figure 1A) was performed and confirmed multiple, ill-defined, irregular, heterogeneously enhanced nodes in the left axillary area, with the largest measuring 47 mm. Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) (Figure 1B) showed multiple enlarged lymph nodes in the deep muscles of the left axilla and the left anterior upper chest wall that were radioactively concentrated.
Splenectomy for solitary splenic metastasis. (A) CT showing a hypodense mass in the spleen that was heterogeneously enhanced after an enhanced scan (arrow). (B) PET/CT showing evidently increased FDG uptake of the splenic mass (arrow); SUVmax: 32.2; no sign of malignant tumor metabolism in the remaining body parts. (C) Specimen obtained post-splenectomy.
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After 19 months of regular follow-up, an abdominal computerized tomography (CT) scan (Figure 2A) revealed a single, hypodense, and heterogeneously enhanced lesion inside the spleen that was 54 x 51 mm in size. Further 18F-FDG PET/CT (Figure 2B) showed that FDG uptake was evidently increased, and the maximum of standardized uptake values (SUV) was 32.2. At 2 weeks after pneumococcal vaccination, the patient underwent laparoscopic splenectomy on July 14, 2021 (Figure 2C).
Histopathological analysis from a splenic lesion. (A) Microphotography showing poorly differentiated tumor cells (H&E, x40). (B) 30% positive immunostaining for Ki67 (H&E, x40). (C) Diffuse and strong positive for CerbB2 (H&E, x40). (D) Diffuse strong nuclear staining for GATA3 (H&E, x40).
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The postoperative pathological outcome was poorly differentiated carcinoma (Figure 3).