Metachronous second primary malignancies in known breast cancer patients on 18F-fluoro-2-deoxyglucose positron emission tomography–computerized tomography in a tertiary care Center

Abstract

Introduction:Breast cancer is the most common malignancy among women all over the world, which accounts to 25% of all cancers. In known cases of breast cancer, the risk of developing another denovo malignancy is more when compared to low risk groups, which might be due to common environmental risk factors, treatment induced risk factors, Genetic susceptibility for mutations, presence of cancer syndromes or better detection due to close surveillance.Objective:To study the profile of Metachronous 2nd primary malignancies suspected on 18F-FDG PET CT in known Breast cancer patients. In this Retrospective study from January 2014 to April 2018, all the consecutive patients with known Breast cancer, who were referred to Nuclear Medicine department for 18F- FDG PET CT for follow up evaluation were included. Suspected 2nd primary malignancies were correlated with Histopathological examination (HPE).Results:During the study period, a total of 233 Breast cancer patients (all are females), with a mean age of 54.2+13.4 years were studied. On 18F-FDG PET CT scan, suspicion for 2nd primary malignancy was observed in 37 patients. HPE was done in 28/37 patients at the site of suspected lesions. 15/28 were positive for second malignancy, and remaining 13/28 were either a benign pathology or a part of metastatic disease from the primary breast cancer. The sites of 2nd primary malignancies included Contralateral breast in 8/15 (53.3%), Ovary in 2/15 (13.3%), Endometrium in 2/15 (13.3%), Lung in 1/15 (6.6%), Stomach in 1/15 (6.6%) and Urinary bladder in 1/15 (6.6%) patients respectively. The incidence of metachronous 2nd primaries in breast cancer is 67.3 per 1000 breast cancer patients.Conclusion:Metachronous second primary cancers in breast cancer patients are not very rare. A high imaging suspicion on 18F-FDG PET CT helps in early detection of 2nd primary cancer, thereby facilitating early and appropriate management.

An Unexpected Diagnosis of Second Primary Malignancy in a Breast Cancer Survivor: A Case Report

“…However, with increased survivorship, patients may also face a number of long-term sequelae such as being diagnosed with a second primary cancer. It can be difficult to diagnose these second primary malignancies in breast cancer survivors because they might be mistaken for the more frequent metastatic recurrence of the disease [ 4 ]. The prognosis and treatment choices for the two must be distinguished since they are distinct entities.…”

Metastatic Breast Cancer Presenting as Progressive Ophthalmoplegia 30 Years After Initial Cancer Diagnosis

“…The initial histopathology was unavailable to us for comparative genotyping, which makes it possible that she had multiple primary malignant neoplasms (MPMN) of the breast, rather than recurrence of the same malignancy. A retrospective study of patients with breast cancer found that 3.6% (8/223), when they were specifically assessed, had a second primary malignant breast neoplasm, over a 4 year period of analysis (6). MPMN is also more common in patients with BRCA1 or BRCA2 gene mutations, and our patient was lost to follow-up, so her BRCA status remains unknown.…”