Multiple uptake of ^99mTc‐MDP in chest due to breast implant rupture in a patient with lung adenocarcinoma

Key Clinical Message

A 57‐year‐old woman was diagnosed as lung adenocarcinoma. ^99mTc‐MDP bone scan showed multiple radioactivity concentrated lesions on bilateral chest wall, which were confirmed as calcification foci after breast implant rupture by SPECT/CT. SPECT/CT could be used for differential diagnosis of breast implant rupture and malignant lesions.

1. CASE DESCRIPTION

A 57‐year‐old female was diagnosed as advanced bilateral lung adenocarcinoma, as shown in pathological examination (Figure 1A) and immunohistochemistry detection (Figure 1B, red arrow). ^99mTc‐MDP whole‐body bone scan (Siemens Symbia Intevo, Germany) was performed to rule out possible bone metastasis. It demonstrated multiple radioactivity concentrated lesions on bilateral chest wall (Figure 2A). To further identify the location and characteristics of the lesions, SPECT/CT was performed in the chest. The SPECT showed radioactive lesions were in breasts (Figure 2B–D, black arrows). CT showed bilateral mammary gland structure disorganized, and multiple encysted hypodense areas in and around the mammary gland, with multiple calcification foci on the capsules (Figure 2E–G, white arrows), which were the radioactive concentration foci on SPECT/CT fusion imaging (Figure 2H–J, white arrows). Some calcifications extended to left axilla, without evidence of malignancy. Tracing the patient's history, she admitted to have received breast polyacrylamide hydrogel injection 20 years ago. The increased uptake of radioactive agent was due to breast prostheses rupture; however, it was a spontaneous event without recollection of trauma for her.

FIGURE 1.

(A) HE staining of the pathological biopsy of the patient's lung lesion. (×40). (B) Immunohistochemical staining. (×20). As one of the lung adenocarcinoma indicators, the TTF‐1 expression was positive (red arrow).

FIGURE 2.

^99mTc‐MDP whole‐body bone scan showing multiple radioactivity concentrated lesions on bilateral chest wall (A). Chest SPECT showing the radioactive lesions were in breasts (B–D, black arrows). CT showing multiple encysted hypodense areas in and around mammary glands, with multiple calcifications in the capsules (E–G, white arrows). SPECT/CT fusion imaging confirmed the location of the increased radioactivity was in the calcifications in breasts (H–J, white arrows).

On MRI, the patient's breasts prostheses were shown with abnormal morphology and signal (Figure 3A,B). The prostheses showed ring‐like enhancement with multiple abnormally enhanced nodules (Figure 3C,D, white arrows). It confirmed breast prostheses rupture and extravasation. Although the patient did not receive breast biopsy, the time–signal intensity curve (TIC) of the ring‐enhancement region on MRI (Figure 3E, red arrow) showed rapid enhancement in the initial phase and gradual enhancement in the delayed phase (Figure 3F), indicating the lesions to be benign. No evidences of breast malignant tumors were seen.

FIGURE 3.

MRI images of breast. (A) Cystic T2 hyperintensity was seen in the posterior and peri‐breasts. (B) Cystic masses in the outer and lower quadrant of the left breast (white arrow). The prosthesis extravasation was considered. After injection of contrast agent, the lesions showed ring enhancement (C, white arrow), with multiple abnormal enhanced nodules (D, white arrow). TIC of the ring‐enhancement region (E, red arrow) showed rapid enhancement in the initial phase and gradual enhancement in the delayed phase (F), indicating the lesions was benign.

2. DISCUSSION

Breast augmentations is one of the most common operations for many women for aesthetic reason. ¹ The commonly used breast augmentations include polyacrylamide hydrogel direct injection, silicone implantation, and autologous fat implantation. ² Polyacrylamide hydrogel injection is to inject polyacrylamide hydrogel into retromammary space, to make breasts plump and large. After injection, the fibrous tissue gradually wraps around the hydrogel prosthesis to form a thin fibrous capsule, which appears as a thin capsule in medical imaging examinations. ³ External force, elasticity, or pressure changes of local breast, and some other reasons could cause the fibrous capsule rupture. Then, the hydrogel in the capsule may diffuse into surrounding tissue space and redistribute, destabilizing the prosthesis. ⁴ A large amount of diffused hydrogel is distributed in the form of scattered lumps and nodules in the breast, or in the subcutaneous tissue, or even outside the breasts. Previous studies have reported some complications after polyacrylamide hydrogel injection, such as pain, implant displacement, subcutaneous induration, infection, hematoma, ectopectoralis inflammation, gelatinous pseudotumor (silicone granuloma), mammary gland atrophy, and lactation dysfunction. ⁵ Therefore, a differential diagnosis is required for those patients who have received breast implants and may have chest wall lesions. In addition to ^99mTc‐MDP SPECT/CT, ¹⁸F‐FDG PET/CT could also be used for the differential diagnosis of breast implant rupture and malignant lesions.

3. CONCLUSION

In this case, the patient's hydrogel prostheses ruptured, followed by capsule calcification, and ^99mTc‐MDP was adsorbed to the capsule. No malignant bone metastasis was observed.

AUTHOR CONTRIBUTIONS

Haibin Chen: Data curation; writing – original draft; writing – review and editing. Yao Chen: Data curation; writing – original draft; writing – review and editing. Xiaoji Liu: Writing – original draft. Min Cai: Data curation; project administration; writing – review and editing.

FUNDING INFORMATION

This study was supported by the Fundamental Research Program of Shanxi Province (grant number 202103021224377).

CONFLICT OF INTEREST STATEMENT

The authors declare that there is no conflict of interest.

ETHICS STATEMENT

The article describes a case report. Therefore, no additional permission from our Ethics Committee was required.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.

Chen H, Chen Y, Liu X, Cai M. Multiple uptake of ^99mTc‐MDP in chest due to breast implant rupture in a patient with lung adenocarcinoma. Clin Case Rep. 2023;11:e7578. doi: 10.1002/ccr3.7578

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.