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A rare case of clear cell carcinoma of the breast evaluated by 18F-FDG PET/CT
Un caso poco frecuente de carcinoma de células claras de la mama evaluado con 18F-FDG PET/TC
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The <span class="elsevierStyleSup">99m</span>Tc-macroaggregated albumin lung perfusion scan in the supine position shows only pulmonary activity (A). The <span class="elsevierStyleSup">99m</span>Tc-macroaggregated albumin injection in sitting position, note the extrapulmonary accumulation of the radio-labeled albumin in the kidneys and the brain (B).</p>" ] ] ] "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" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "A rare case of clear cell carcinoma of the breast evaluated by <span class="elsevierStyleSup">18</span>F-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" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "U." "apellidos" => "Perriard" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Ceriani" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Giovanella" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "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 <span class="elsevierStyleSup">18</span>F-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" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Maximum-intensity-projection <span class="elsevierStyleSup">18</span>F-FDG PET image (A), axial non-enhanced CT (B) and fused PET/CT image (C) showing increased tracer uptake corresponding to a 8<span class="elsevierStyleHsp" style=""></span>cm mass located in the left breast (arrows) with a SUV<span class="elsevierStyleInf">max</span> 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).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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 <span class="elsevierStyleSup">18</span>F-FDG PET/CT scan was performed for staging before surgical planning.</p><p id="par0010" class="elsevierStylePara elsevierViewall">PET/CT images were acquired one hour after i.v. injection of 270<span class="elsevierStyleHsp" style=""></span>MBq of <span class="elsevierStyleSup">18</span>F-FDG. Glucose blood levels corresponded to 92<span class="elsevierStyleHsp" style=""></span>mg/dL before radiopharmaceutical injection. PET/CT showed an area of increased <span class="elsevierStyleSup">18</span>F-FDG uptake corresponding to a 8<span class="elsevierStyleHsp" style=""></span>cm mass in the left breast (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A–C) with a maximum standardized uptake value (SUV<span class="elsevierStyleInf">max</span>) of 22. No other areas of abnormal <span class="elsevierStyleSup">18</span>F-FDG uptake were detected in the rest of the body. Negative results outside breast with <span class="elsevierStyleSup">18</span>F-FDG PET/CT enhanced the surgical decision to perform left mastectomy and ipsilateral axillary lymph node dissection.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">To the best of our knowledge, no cases describing <span class="elsevierStyleSup">18</span>F-FDG PET/CT findings in this rare breast tumor are reported in the literature. Conversely, it was demonstrated that <span class="elsevierStyleSup">18</span>F-FDG PET/CT may provide useful information in patients with locally advanced breast carcinoma.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We have described an increased uptake of <span class="elsevierStyleSup">18</span>F-FDG in this rare malignancy. Furthermore, in our case, <span class="elsevierStyleSup">18</span>F-FDG PET/CT has been useful in staging before surgical planning.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-10-12" "fechaAceptado" => "2014-11-13" "multimedia" => array:1 [ 0 => 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" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Maximum-intensity-projection <span class="elsevierStyleSup">18</span>F-FDG PET image (A), axial non-enhanced CT (B) and fused PET/CT image (C) showing increased tracer uptake corresponding to a 8<span class="elsevierStyleHsp" style=""></span>cm mass located in the left breast (arrows) with a SUV<span class="elsevierStyleInf">max</span> 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).</p>" ] ] ] "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" => "<span class="elsevierStyleSup">18</span>F-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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