Abstract
A 54-year-old woman underwent [18F] FDG PET/CT for assessment of a voluminous ascites with an infiltrating lesion on the left breast at clinical examination. PET-CT revealed a large left breast lesion with homolateral axillary lymph nodes and a left iliac lytic bone lesion, but also hepatomegaly with diffuse and extensive uptake with brain and renal hypometabolism. The result suggest an hepar lobatum carcinomatosum with sequestration of the radiotracer in the liver with a reduction of the background physiological activity. This “hot liver aspect” means being cautious about the risk of a false-negative lesion at staging.
Key Words: FDG, PET, breast cancer, hepar lobatum carcinomatosum, hot liver
FIGURE 1.
A 54-year-old woman underwent [18F] FDG PET/CT for assessment of a voluminous ascites with an infiltrating lesion on the left breast at clinical examination.1 PET-CT revealed a large left breast lesion with homolateral axillar lymph nodes and a left iliac lytic bone lesion (A–C, blue head arrows), but also hepatomegaly with diffuse and extensive uptake (A–E, yellow arrows). The result suggest an hepar lobatum carcinomatosum2 with hepatic dysmophia probably secondary to metastatic breast cancer and massive abdominal ascites. Major hepatic hypermetabolism (with SUVmax = 10.1) was associated with a reduction of the background physiological activity, particularly in the brain and kidneys (A–E, green head arrows). The patient underwent ultrasound microbiopsy of the breast lesion with histologic findings consistent with grade III NST breast adenocarcinoma of RB2 phenotype with ER and PR negative and HER positive status.3 Usually, hepar lobatum carcinomatosum was more frequent in invasive lobular carcinoma histology.4 Ultrasound microbiopsy of the left axillary adenomegaly confirmed a metastatic node. Cytopuncture of the left supraclavicular lymph node was inconclusive, as the inclusion block contained only debris. Cytology of ascitic fluid did not find metastatic cells, being probably linked to induced portal hypertension. Following this assessment, the patient began chemotherapy with anti-HER2 therapies by paclitaxel-pertuzumab-trastuzumab.5 As in many other diseases,6,7 massive hepatic infiltration indicates aggressive disease and is a poor-prognosis factor with high risk of acute liver failure.8–10 In our case, this “hot liver aspect”11,12 with massive sequestration of the radiotracer requires caution regarding the risk of falsifying the stage assessment by underestimating the fixation of secondary lesions.
Footnotes
Conflicts of interest and sources of funding: none declared.
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