A Case of Intraductal Papilloma of the Breast With High 18F-FDG Uptake on PET/CT

Intraductal Papilloma With Carcinoma of the Breast Described by Dedicated Breast 18F-FDG PET

ABSTRACT

Intraductal papilloma (IDP) is a benign tumor of the breast. However, IDP has been reported to show high uptake of 18F-FDG using whole-body PET. We experienced IDP with low-grade ductal carcinoma in situ using dedicated breast PET, which is more sensitive than whole-body PET. The 18F-FDG uptake of the whole tumor was high, and differentiation between the carcinoma and the residual benign lesion was difficult. This is the first report of IDP detected with dedicated breast PET. Diagnosis of IDP is sometimes controversial; papilloma may show glucose uptake similar to that of low-grade carcinoma.

Post Contusion Breast Hematoma Mimicking Malignancy on FDG PET/CT

A 32-year-old woman was treated for breast carcinoma. Posttreatment FDG PET/CT scan revealed complete response, but in the contralateral breast, unexpected incidental intense FDG uptake was seen with a differential diagnosis of both malignant and benign causes. Medical history revealed recent breast contusion. The lesion was further evaluated by mammogram and ultrasound, which were compatible with deep breast bruise. Histopathology showed no malignancy. Subsequent FDG PET/CT study showed breast uptake normalization. This case shows that postcontusion breast hematoma can cause a potential pitfall mimicking breast malignancy on FDG PET/CT.

A case of giant complicated intraductal papilloma of breast on MRI and literature review

BACKGROUND

With the increasing use of image-guided biopsy, more breast intraductal papillomas are found than ever. Most intraductal papillomas are small, ranging from several milimeters to 2 cm.

CASE

We described a case of giant intraductal papilloma of breast in a 19-year-old girl with nipple bloody discharge and rapid growth. Magnetic resonance imaging diagnostic evaluation and pathologic correlation along with review of relevant literatures are documented. The lesion was characterized by presence of mixture of cystic and solid component with cystic component occupying a large space. The solid component showed morphologic, kinetic, and diffusion weighted imaging features suggestive of malignancy. Infarction with no enhancement was noted. Cystic compartments contained hemorrhage with fluid-fluid level formation. The patient undertook lumpectomy.

CONCLUSION

For a giant breast tumor with mixed solid and cystic component, intraductal papilloma should be considered in the differential diagnosis.

Spectrum of the Breast Lesions With Increased 18F-FDG Uptake on PET/CT

Interpretation of ¹⁸F-FDG PET/CT studies in breast is challenging owing to nonspecific FDG uptake in various benign and malignant conditions. Benign conditions include breast changes in pregnancy and lactation, gynecomastia, mastitis, fat necrosis, fibroadenoma, intraductal papilloma, and atypical ductal hyperplasia. Among malignancies, invasive ductal carcinoma and invasive lobular carcinoma are common histological types of breast carcinoma. Rarely, other unusual histological types of breast carcinomas (eg, intraductal papillary carcinoma, invasive micropapillary carcinoma, medullary carcinoma, mucinous carcinoma, and metaplastic carcinoma), lymphoma, and metastasis can be the causes. Knowledge of a wide spectrum of hypermetabolic breast lesions on FDG PET/CT is essential in accurate reading of FDG PET/CT. The purpose of this atlas article is to demonstrate features of various breast lesions encountered at our institution, both benign and malignant, which can result in hypermetabolism on FDG PET/CT imaging.