Hu Tianyuan, Zhang Rongqin, Zhang Bing, He Shanzhen, Liu Lian, Zou Yan, Huang Junhao, Wang Bing, Hu Ping, Zhang Zhanwen
Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China.
Front Oncol. 2023 Feb 22;13:1106890. doi: 10.3389/fonc.2023.1106890. eCollection 2023.
Occult breast cancer is an uncommon type of breast cancer and its diagnosis is challenging. It is usually invisible on multiple imaging examines. Metastases to the rectum and inguinal lymph nodes from occult breast lobular cancer are even rarer. Ga-DOTA peptides can image neuroendocrine tumors by targeting specific somatostatin receptors. Besides, other tumors, including breast cancer, have been shown to express somatostatin receptors. In this case, we presented a 63-year-old woman who underwent both F-FDG and Ga-DOTATATE PET/CT due to a rectal polyp. An endoscopic excision biopsy confirmed metastatic carcinoma of suspected breast origin, but subsequent ultrasound and MRI showed no signs of malignancy in the breast and adnexa uteri. PET/CT showed obvious Ga-DOTATATE activity in bilateral axillary and right inguinal lymph nodes with mild F-FDG uptake. Final histopathology at the left axillary, right inguinal lymph nodes, and rectum indicated metastases from breast cancer while the origin remained radiologically occult. Additionally, one uterine fibroids was found with positive uptake of Ga-DOTATATE and negative uptake of F-FDG. This case suggested that Ga-DOTATAE PET/CT may be an effective supplement in diagnosing OBC lymph node metastases with mild F-FDG uptake, and it may provide a new technology for the clinical diagnosis of occult breast cancer.
隐匿性乳腺癌是一种罕见的乳腺癌类型，其诊断具有挑战性。它通常在多种影像学检查中不可见。隐匿性乳腺小叶癌转移至直肠和腹股沟淋巴结的情况更为罕见。镓标记的DOTA肽可通过靶向特定的生长抑素受体对神经内分泌肿瘤进行成像。此外，包括乳腺癌在内的其他肿瘤也已被证明表达生长抑素受体。在本病例中，我们报告了一名63岁女性，因直肠息肉接受了F-FDG和镓标记的DOTA-TATE PET/CT检查。内镜切除活检证实为疑似乳腺来源的转移性癌，但随后的超声和MRI检查显示乳腺及子宫附件无恶性征象。PET/CT显示双侧腋窝和右侧腹股沟淋巴结有明显的镓标记的DOTA-TATE活性，F-FDG摄取轻度。左腋窝、右腹股沟淋巴结及直肠的最终组织病理学检查表明为乳腺癌转移，而原发灶在影像学上仍隐匿。此外，还发现一个子宫肌瘤，其镓标记的DOTA-TATE摄取阳性，F-FDG摄取阴性。该病例提示，镓标记的DOTA-TATE PET/CT可能是诊断F-FDG摄取轻度的隐匿性乳腺癌淋巴结转移的有效补充手段，可为隐匿性乳腺癌的临床诊断提供新技术。
