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  Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 2  |  Page : 167-168
 

Metastasis to bilateral breasts from maxillary embryonal rhabdomyosarcoma demonstrated on F-18 FDG PET/CECT


1 Division of PET Imaging, Molecular Imaging and Research Centre, Shahdara, Delhi, India
2 Delhi State Cancer Institute, Guru Teg Bahadur Hospital, Shahdara, Delhi, India
3 Cytopathology Lab, Institute of Nuclear Medicine and Allied Sciences, Shahdara, Delhi, India

Date of Web Publication5-Feb-2016

Correspondence Address:
M Tripathi
Division of PET Imaging, Molecular Imaging and Research Centre, Shahdara, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175809

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How to cite this article:
Tripathi M, Mahajan S, Nanda S, DíSouza M, Bhalla J S. Metastasis to bilateral breasts from maxillary embryonal rhabdomyosarcoma demonstrated on F-18 FDG PET/CECT. Indian J Cancer 2015;52:167-8

How to cite this URL:
Tripathi M, Mahajan S, Nanda S, DíSouza M, Bhalla J S. Metastasis to bilateral breasts from maxillary embryonal rhabdomyosarcoma demonstrated on F-18 FDG PET/CECT. Indian J Cancer [serial online] 2015 [cited 2021 Aug 5];52:167-8. Available from: https://www.indianjcancer.com/text.asp?2015/52/2/167/175809


Sir,

A 14-year-old female diagnosed as a case of embryonal rhabdomyosarcoma (ERMS) of right maxilla on histopathological examination was referred for F-18 Flourodeoxyglucose (FDG) Positron emission tomography/Contrast Enhanced Computed Tomography (PET/CECT for primary staging. 222 MBq of F-18 FDG was injected intravenously and the patient was rested for one hour followed by the PET/CECT acquisition on a Discovery STE 16 camera (GE). Contrast enhanced CT of the head and neck and thorax was followed by a low dose CT and 3D PET emission scan from head to thigh at two minutes per incremental bed position. Following 3D VUE reconstruction images were viewed on a Xeleris workstation (GE) using the volumetrix protocol. On evaluation of the maximum intensity projection (MIP) image [Figure 1]a abnormal FDG accumulation was noted in the primary soft tissue mass arising from the right maxilla and also in multiple, well defined rounded enhancing lesions of variable sizes in both breasts [Figure 1]b. On retrospective clinical examination multiple, painless, well circumscribed and freely movable lumps were found palpable in both breasts, the presence of which had been hidden by the patient. Keeping in mind the possibility of bilateral breast metastasis the patient was referred for fine needle aspiration cytology (FNAC) from the breast masses which revealed features of a round cell tumour morphologically similar to that of the primary [Figure 2]. Metastatic ERMS of the breast is rare, although it is postulated to be a preferential metastatic site in adolescent girls.[1],[2] The propensity of tumors to metastasize to the breasts of young women has been attributed to the blood supply to the developing breasts. In fact following an analysis of 189 cases with metastatic RMS, 3.7% patients were identified with breast involvement at diagnosis and all were females aged 13-17 years.[3] It has thus been suggested that investigation of the mammary region should be part of the usual diagnostic workup in adolescent girls with alveolar RMS, the subtype most commonly associated with metastatic to the breasts. Two cases with orbital RMS, embryonal subtype with metastasis to bilateral breasts have been reported.[4] Such cases carry a relatively better prognosis than alveolar subtypes. In our case the RMS was embryonal and the primary site was maxilla. Solitary metastasis to the breast from maxillary ERMS has been reported in a 30 year female where it needed to be distinguished from a primary breast malignancy.[5] Traditional diagnostic imaging methods for the evaluation of musculoskeletal tumors include ultrasound, CT, MRI and bone scintigraphy. FDG PET/CT has been reported as superior to conventional imaging modalities in the staging and restaging of rhabdomyosarcomas.[6] This case illustrates the useful role that this modality can play in staging of RMS.
Figure 1: (a) The maximum intensity projection image revealed abnormal FDG accumulation in the right maxillary region (A-thick arrow) and also in both breasts (A-thin arrows). (b) The fused transaxial images at the level of the breasts revealed FDG accumulation in multiple, well defined rounded enhancing lesions of variable sizes in both breasts (arrows)

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Figure 2: Fine needle aspiration cytology slide from the breast masses which revealed features of a round cell tumor morphologically similar to that of the primary tumor (H and E, ×20)

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 Ľ References Top

1.
Sneige N, Zachariah S, Fanning TV, Dekmezian RH, Ordonez NG. Fine-needle aspiration cytology of metastatic neoplasms of breast. Am J Clin Pathol 1989;92:27-35.  Back to cited text no. 1
    
2.
Pettinato G, Manivel JC, Kelly DR, Wold LE, Dehner LP. Lesions of the breast in children exclusive of typical fibroadenoma and gynecomastia. A clinicopathologic study of 113 cases. Pathol Annu 1989;24 (Pt 2):296-328.  Back to cited text no. 2
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3.
D'Angelo P, Carli M, Ferrari A, Manzitti C, Mura R, Miglionico L, et al. Breast metastases in children and adolescents with rhabdomyosarcoma: Experience of the Italian soft tissue sarcoma committee. Pediatr Blood Cancer 2010;55:1306-9.  Back to cited text no. 3
    
4.
Rai B, Ghosal S, Sharma SC, Nijhawan R, Bansal M. Breast metastasis of embryonal rhabdomyosarcoma of orbit. Indian J Surg 2003;65:366-7.  Back to cited text no. 4
    
5.
Lai CR, Hsu CY, Tsay SH, Hung-Chiang. Adult embryonal rhabdomyosarcoma metastatic to the breast diagnosed by fine needle aspiration. A case report. Acta Cytol 1997;41:845-8.  Back to cited text no. 5
    
6.
Tateishi U, Hosono A, Makimoto A, Nakamoto Y, Kaneta T, Fukuda H, et al. Comparative study of FDG PET/CT and conventional imaging in the staging of rhabdomyosarcoma. Ann Nucl Med 2009;23:155-61.  Back to cited text no. 6
    


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