Splenic metastasis of breast cancer: A rare metastatic site depicted on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography

Sir,

Metastatic involvement of the spleen in solid tumors is quite a rare entity and usually accompanied by disseminated visceral metastases that indicating terminal stage.[123] A large-scale autopsy based retrospective study showed that, the prevalence of splenic metastasis in patients with the malignant solid tumor was 3.0%, and breast cancer was a primary tumor in only 12.3% of all these spleen metastases.[1] Herein, we presented a rare case of splenic metastasis of breast cancer detected by fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT).

A 71-year-old female presented with a palpable breast mass was subjected to Tru-cut needle (14GX15cm, Gallini MD, Istanbul, Turkey) biopsy. Based on histologic findings a diagnosis of infiltrating ductal carcinoma was made. Then she was referred for a whole body PET scan for initial staging. F-18 FDG PET/CT showed high FDG uptake within the primary lesion, which was seen in the lower inner quadrant of right breast. Multiple FDG avid metastases of right axillary lymph nodes, right lung, liver, and bones were also seen. In addition to these, a 5 cm × 4 cm hypodense mass lesion with intense peripheral FDG uptake in the spleen was detected [Figure 1]. Though lack of histological examination, this finding considered to be a metastasis of primary tumor, due to multiple metastases, which were seen in other sites of the whole body.

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Figure 1 Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography showed intense hypermetabolic primary lesion in the right breast (arrows in a: Positron emission tomography, computed tomography, and fusion positron emission tomography/computed tomography images). Multiple moderate-intense hypermetabolic metastatic lesions were also seen in the right axilla, right lung, liver, and bones (b: Maximum intensity projection image). In addition to these, intense hypermetabolic hypodense lesion with 5 cm × 4 cm in diameter in the spleen was detected (arrows in c: Positron emission tomography, computed tomography, and fusion positron emission tomography/computed tomography images)

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Regional and distant lymph nodes, bones, lungs, liver, and brain are the most common sites of metastatic spread in breast cancer. Whereas, splenic metastasis from breast cancer is quite rare, and only a few cases have been reported.[3] Though histology from the splenic site is not available, but there is little doubt that it is not a metastatic involvement, given the widespread disease on whole body FDG PET/CT scan and hypodense lesion on CT images.[34] To our knowledge, this is the first report of this unusual behavior of breast cancer that showed on F-18 FDG PET/CT.