A rare case of clear cell carcinoma of the breast evaluated by 18F-FDG PET/CT

Treglia, G.; Perriard, U.; Ceriani, L.; Giovanella, L.

doi:10.1016/j.remnie.2015.05.006

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The 99mTc-macroaggregated albumin lung perfusion scan in the supine position shows only pulmonary activity (A). The 99mTc-macroaggregated albumin injection in sitting position, note the extrapulmonary accumulation of the radio-labeled albumin in the kidneys and the brain (B)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.P. Fierro Alanis, I. Bastón Rey, S. Nieves-Maldonado, J.A. Torre Carballada, J.E. Domínguez-Muñoz, Á. Ruibal Morell" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M.P." "apellidos" => "Fierro Alanis" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Bastón Rey" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Nieves-Maldonado" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "Torre Carballada" ] 4 => array:2 [ "nombre" => "J.E." "apellidos" => "Domínguez-Muñoz" ] 5 => array:2 [ "nombre" => "Á." "apellidos" => "Ruibal Morell" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000634?idApp=UINPBA00004N" "url" => "/22538089/0000003400000004/v1_201506250030/S2253808915000634/v1_201506250030/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "Interesting image" "titulo" => "A rare case of clear cell carcinoma of the breast evaluated by 18F-FDG PET/CT" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "264" "paginaFinal" => "265" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. Treglia, U. Perriard, L. Ceriani, L. Giovanella" "autores" => array:4 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Treglia" "email" => array:1 [ 0 => "giorgiomednuc@libero.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "U." "apellidos" => "Perriard" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Ceriani" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Giovanella" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Institute of Pathology, Locarno, Switzerland" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un caso poco frecuente de carcinoma de células claras de la mama evaluado con 18F-FDG PET/TC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1087 "Ancho" => 1500 "Tamanyo" => 348029 ] ] "descripcion" => array:1 [ "en" => "Maximum-intensity-projection 18F-FDG PET image (A), axial non-enhanced CT (B) and fused PET/CT image (C) showing increased tracer uptake corresponding to a 8cm mass located in the left breast (arrows) with a SUVmax of 22. At hematoxylin and eosin stain the breast mass was composed by large cells arranged into a solid pattern and characterized by abundant vacuolated clear cytoplasm, marked nuclear pleomorphism and high number of mitoses (D). The proliferative index (Ki67%) was 80% (E)." ] ] ] "textoCompleto" => "A 53-year-old woman with a palpable mass in the left breast with coexisting skin ulceration at physical examination underwent breast ultrasonography (US) for staging. US showed a large inhomogeneous and hypervascular mass in the left breast and enlarged lymph nodes in the left axilla. US-guided biopsy demonstrated the presence of a clear cell carcinoma (CCC) of the breast. The patient refused neoadjuvant chemotherapy and a 18F-FDG PET/CT scan was performed for staging before surgical planning.PET/CT images were acquired one hour after i.v. injection of 270MBq of 18F-FDG. Glucose blood levels corresponded to 92mg/dL before radiopharmaceutical injection. PET/CT showed an area of increased 18F-FDG uptake corresponding to a 8cm mass in the left breast (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A–C) with a maximum standardized uptake value (SUVmax) of 22. No other areas of abnormal 18F-FDG uptake were detected in the rest of the body. Negative results outside breast with 18F-FDG PET/CT enhanced the surgical decision to perform left mastectomy and ipsilateral axillary lymph node dissection.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>At hematoxylin and eosin stain the breast mass was composed by large cells arranged into a solid pattern and characterized by abundant vacuolated clear cytoplasm, marked nuclear pleomorphism and high number of mitoses (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). This tumor did not express estrogen receptor alpha, progesterone receptor, or human epidermal growth factor receptor 2 (“triple-negative” feature). The proliferative index (Ki67%) was 80%. A final diagnosis of CCC of the left breast without metastatic spread was performed (final stage after surgery: T4N0M0) and the patient was addressed to adjuvant radiation therapy.CCC is a rare malignant tumor of the breast, accounting for 0.9%-2.8% of all breast cancer cases. Most of these tumors are invasive carcinomas with a poor prognosis. The histology appearance of CCC is typical as these tumors are composed almost entirely of polygonal cells with clear cytoplasm. The immunophenotype of CCC is not uniform, but it is similar to that of conventional ductal carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>To the best of our knowledge, no cases describing 18F-FDG PET/CT findings in this rare breast tumor are reported in the literature. Conversely, it was demonstrated that 18F-FDG PET/CT may provide useful information in patients with locally advanced breast carcinoma.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>We have described an increased uptake of 18F-FDG in this rare malignancy. Furthermore, in our case, 18F-FDG PET/CT has been useful in staging before surgical planning." 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The proliferative index (Ki67%) was 80% (E)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinicopathologic characteristics and prognosis of glycogen-rich clear cell carcinoma of the breast" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "X. Ma" 1 => "Y. Han" 2 => "Y. Fan" 3 => "X. Cao" 4 => "X. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/tbj.12231" "Revista" => array:6 [ "tituloSerie" => "Breast J" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "166" "paginaFinal" => "173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24400866" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraductal glycogen-rich clear cell carcinoma of the breast: a rare presentation and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N.S. Salemis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000341393" "Revista" => array:6 [ "tituloSerie" => "Breast Care" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "319" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23904836" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "18F-FDG semi-quantitative parameters and biological prognostic factors in locally advanced breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M. García Vicente" 1 => "A. Soriano Castrejón" 2 => "F. Relea Calatayud" 3 => "V. Muñoz Madero" 4 => "M.J. Molina Garrido" 5 => "A.A. León Martín" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.remn.2011.12.001" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Med Nucl Imagen Mol" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "308" "paginaFinal" => "314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23084013" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003400000004/v1_201506250030/S2253808915000592/v1_201506250030/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003400000004/v1_201506250030/S2253808915000592/v1_201506250030/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000592?idApp=UINPBA00004N"]

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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.

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Vol. 34. Issue 4.

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