No Restriction on DWI and Low Uptake in PET CT in a Genital Metastasis from Breast Lobular Cancer
Objectives
Metastasis of breast cancer to genital organs is rare and the ovaries are the most common site of metastasis from extra-genital primary cancer. Invasive lobular carcinoma (ILC) is the most frequent type of breast cancer causing distant metastasis.
Case report
A 41-year-old woman with past medical history of right breast invasive lobular carcinoma and breast conservative surgery 3 years before presenting with abnormal vaginal bleeding. Ultrasound showed bilateral solid appearing ORADS 4 masses and endometrial thickening. The endometrial lesion and bilateral adnexal masses did not show significant restriction on the MRI DWI sequences, nor did they exhibit any significant uptake on the PET scan images. Surgical pathology of total abdominal hysterectomy and bilateral oophorectomy confirmed infiltrating lobular carcinoma in the uterus and both adnexa originating from the breast. Here we are presenting a known case of breast cancer with extensive metastasis to genital organs.
Conclusion
It is necessary for radiologists to be informed about the exact previous history of breast cancer, its histopathological subtype, and the extension of the disease when they encounter with a known case of breast cancer patient diagnosed by ovarian masses in imaging. Metastasis from lobular carcinoma of the breast to genital organs can appear low uptake in PET and without restriction on DWI images of MRI due to its infiltrative pattern of involvement. Therefore, PET/CT and MRI are not perfect techniques for rule out metastasis in these patients.
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