Breast metastases are uncommon findings compared to primary breast cancer and in particular bilateral secondary breast lesions from neuroendocrine tumor (NET)s are extremely rare with just less over 13 cases described in literature. We reported herewith the case of a 54-year-old woman who presented to our Breast Unit after noticing multiple, mobile, bilateral breast lumps. Imaging studies confirmed the presence of multiple, circumscribed, bilateral breast masses with slightly spiculated margins, classified as suspicious for malignancy (BI-RADS 4). A tru-cut biopsy was carried out on the largest lesion of each side and histopathologic and immunohistochemistry examination was consistent with metastases from pancreatic neuroendocrine tumor (PNET). Total-body CT revealed the presence of a mass located in the pancreatic body - tail with associated abdominal lymphadenopathies and multiple secondary nodules in bilateral breast and in the liver. Stage IV disease was diagnosed, patient did not undergo surgery and started LAR – octreotide therapy. Although rare, breast metastases from NETs represent an important diagnostic challenge for practitioners because of the difficulty to differentiate from a primary breast carcinoma or even from benign breast lesions. Clinicians should be aware of the possibility of bilateral breast metastases in differential diagnosis of breast lesions in order to ensure the correct diagnosis and the most appropriate management of these patients.
Cardiac Positron Emission Tomography (PET) has been demonstrated to be highly specific in differentiating viable from scarred myocardium in patients with ischemic left ventricular dysfunction. The aim of this study was to compare PET imaging with contrast-enhanced magnetic resonance imaging (ceMRI) in patients with ischemic myocardial dysfunction, analysing semiquantitatively the amount of non-viable myocardial tissue. Results: 10 patients with left ventricle ischemic dysfunction underwent myocardial PET with 13 N-ammonia/FDG and delayed sequences of cardiac MRI after injection of gadolinium diethyltriaminepentaacetic acid (Gd-DTPA). PET and MRI images were divided into 17 segments and examined by 2 independent observers. Extent of tissue damage was estimated using a 5point scoring system. Using PET as gold standard, accuracy in detecting scar tissue was determined for ceMRI. High agreement rate (63% and 69%) between myocardial necrosis in PET and ceMRI was evaluated by Kappa test. Comparison between scores in transmutable extension in PET/ceMRI study with a "0 tolerance" system (that is considering results agreement only if overlap results), the 2 blinded observers demonstrated an agreement rate of 68.9% and 76.5% respectively, with a difference of 7.6% [IC 95% from-2 to 17.1]. With one point of tolerance (considering results agreement even if there was one point of difference), an agreement rate of 93.6 and 95.3% emerged, with a difference of 1.8% [IC 95% from-3.1 to 6.6%]. Conclusions: In the identification of non-viable myocardium, semiquantative analysis of cardiac PET and ceMRI obtained similar accuracy of the two imaging techniques.
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