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C as e R epo rt
A bs tra ct
Anterior abdominal wall cutaneous metastases
detected by F-18 fluorodeoxyglucose-positron
emission tomography/computed tomography in
a patient with breast carcinoma
Cutaneous metastases from internal malignancies are rare with a reported incidence
between 0.7% and 10%. It may be the first symptom in 7% of the patients with
cancer. We report a case with distant solitary skin metastases in anterior abdominal
skin from breast cancer detected on F‑fluorodeoxyglucose‑positron emission
tomography/computed tomography imaging.
Key words: Breast cancer, F-18 fluorodeoxyglucose-positron emission tomography/
computed tomography, skin metastases, staging
Koramadai Karuppusamy
Kamaleshwaran,
Sudhakar Natarajan1,
Anjali Malaikkal,
Vyshakh Mohanan,
Ajit Sugunan Shinto
Departments of Nuclear Medicine
and PET/CT and 1Oncology,
Comprehensive Cancer Care
Centre, Kovai Medical Centre and
Hospital Limited, Coimbatore,
Tamil Nadu, India
Address for the Correspondence:
Dr. Koramadai Karuppusamy
Kamaleshwaran,
Department of Nuclear Medicine,
PET/CT and Radionuclide
Therapy, Comprehensive
Cancer Care Centre,
Kovai Medical Centre and Hospital
Limited, Coimbatore ‑ 641 014,
Tamil Nadu, India.
E‑mail: [email protected]
Access this article online
Website: www.oghr.org
DOI: 10.4103/2348-3113.139658
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INTRODUCTION
Cutaneous metastases from internal malignancies are rare with a reported incidence between
0.7% and 10%.[1] Although the most common carcinoma to metastasize to the skin is malignant
melanoma, seconded by breast carcinoma, breast cancer is very common in females and cutaneous
metastasis of breast cancer is the commonly encountered metastasis in clinical practice.[2,3] We report
a case of distant solitary skin metastases over the anterior abdominal skin from breast cancer,
detected on an F‑18 fluorodeoxyglucose‑positron emission tomography/computed tomography
(F‑18 FDG‑ PET/CT) scan. In addition to the detection of skin metastases, F‑18 FDG‑PET/CT
was also useful in staging the disease.
CASE REPORT
A 45‑year‑old woman diagnosed to have left‑sided breast carcinoma was subjected to F‑18
FDG‑PET/CT [Figure 1a] scan to stage the disease. Intense uptake is noted in the soft tissue lesion
in the left breast and axillary nodes along with FDG avid sclerotic lesion was also noted in the
sternum [Figure 1b]. There was a FDG avid hypodense liver lesion noted in segment I [Figure 1c].
Intense FDG avid skin thickening [standardized uptake value [(SUV) =15] was noted over right
lower abdominal wall [Figure 1d]. Hence, in addition to demonstration of primary breast, bone and
liver metastasis, F‑18 FDG‑PET/CT also revealed unsuspected skin lesion. Clinical examination
revealed a skin lesion in the right abdominal wall. Subsequently, the patient underwent neoadjuvant
chemotherapy.
DISCUSSION
Differential diagnosis of the skin lesions and subcutaneous nodules would include cutaneous
lymphoma, melanoma, neurofibromatosis, and metastases from other internal malignancies.[1] The
breast, stomach, lung, uterus, large intestine, and kidneys are the most frequent internal organs
to produce cutaneous metastases. Cancers that have the highest propensity to metastasize to the
skin include melanoma (45% of cutaneous metastasis cases), breast (30%), nasal sinuses (20%),
larynx (16%), and oral cavity (12%).[2] Because breast cancer is so common, cutaneous metastasis
of breast cancer is the most frequently encountered type of cutaneous metastasis in most clinical
Oncology, Gastroenterology and Hepatology Reports| Jan-Jun 2015 | Vol 4 | Issue 1
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Kamaleshwaran, et al.: Cutaneous metastasis from breast cancer detected by FDG PET/CT
cutaneous metastases may be the presenting symptom it usually
represents advanced disease and poor prognosis. FDG PET‑CT can
potentially be used as a one‑stop‑shop imaging modality in patients
with cutaneous/subcutaneous metastases from FDG avid primary
malignancies. FDG PET‑CT may also find a role in evaluating the
response of these lesions to treatment. In our case, in addition to
demonstration of FDG uptake in skin metastases, PET/CT also
revealed liver and sternal metastases, thereby defining true extent
of the disease. Our case also highlights the fact that F‑FDG avid
nodules in skin in a case of breast carcinoma should always bring
up suspicion of skin metastases.
b
c
REFERENCES
a
d
1.
Figure 1: Whole body fluorodeoxyglucose‑positron emission
tomography/computed tomography (FDG PET/CT) maximum intensity
projection images (a). Axial fused PET/CT showing primary left
breast mass and sternal lesion (b) (arrows). Hypodense mass in the
liver (c) (arrows), and intense FDG uptake with a standardized uptake
value max of 15 in the anterior abdominal wall skin lesion on the right
side (d) (arrows)
practices.[3] Cutaneous metastases can occur either by lymphatic
or hematogenic spread and is most commonly seen in the head
and neck regions and trunk.[4] The recognition of cutaneous
metastases often dramatically alters therapeutic plans, especially
when metastases signify persistence of cancer originally thought
to be cured. Some tumors metastasize with predilection to specific
areas. Recognition of these patterns can be useful in directing the
search for an underlying tumor.
F‑18 FDG–PET/CT has been widely used in staging breast cancer
and shown to be better than conventional imaging modalities and
also changes management in significant number of patients.[5]
However, distant skin metastases from breast cancer detected by
FDG‑PET/CT have been rarely reported in the literature.[6,7] Though
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How to cite this article: Kamaleshwaran KK, Natarajan S,
Malaikkal A, Mohanan V, Shinto AS. Anterior abdominal wall
cutaneous metastases detected by F-18 fluorodeoxyglucosepositron emission tomography/computed tomography in a patient
with breast carcinoma. Onc Gas Hep Rep 2015;4:64-5.
Source of Support: Nil, Conflict of Interest: None declared.
Oncology, Gastroenterology and Hepatology Reports| Jan-Jun 2015 | Vol 4 | Issue 1