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18F-FES PET-CT Scan Turns out a Problem Solving Modality in an ER Positive Metastatic Breast Cancer Patient

Manoj Gupta, Partha S. Choudhury, Maria Dsouza, Robert Louis, Anupama Datta, Anil Mishra

Abstract


Introduction: Two of three breast cancer patients are estrogen receptor positive. Metastasis can present upfront or developed later. Accurate delineation of all metastatic sites and ruling out a concurrent primary is of prime importance. We present a breast cancer case with multiple unusual sites of potential metastatic involvement, wherein 18F-FES PET-CT played a crucial role in resolving the diagnostic dilemma. 

Case Presentation: Treated case of strongly ER positive 52 year old female breast cancer patient presented with chest wall nodule and contralateral axillary lymphnode. FDG PET-CT showed many uncommon sites (scalp nodules, periampullary mass and lung infiltrates) and unsure about metastasis or inflammatory. FES PET-CT was positive in all these sites thus resolve the diagnostic uncertainty.  

Conclusion: FES PET-CT scan can be of immense use as a problem solving modality in ER positive breast cancer. This case highlights the spectrum of metastatic sites potentially be evaluated by FES PET-CT scan which can play a crucial role in decision making and personalized medicine. However, it is important to remember the occurrence of triple negative cases and ER receptor heterogeneity in metastatic sites. 


Keywords


Estrogen receptor; Metastatic breast cancer; 18F-FES PET-CT; Scalp nodules; periampullary mass

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References


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