A Dual-time-point 18F-FDG PET/CT Imaging Unveiled Occult Hepatic Metastasis of Breast Cancer with Neuroendocrine Differentiation
A Case Report
DOI:
https://doi.org/10.59667/sjoranm.v32i2.14Keywords:
Delayed PET/CT, Breast cancer, occult metastasis, diagnostic imaging, liver metastasis, neuroendocrine differentiationAbstract
Breast cancer with neuroendocrine differentiation is a rare entity, often presenting diagnostic challenges due to its atypical imaging features. Standard imaging modalities may fail to detect early metastases, particularly when tumour markers rise in isolation. A 57-year-old woman with a history of right-sided invasive ductal carcinoma (estrogen receptor (ER) positive, progesterone receptor (PR) positive, human epidermal growth factor receptor 2 (HER2) negative) presented seven years after initial management with rising serum carcinoembryonic antigen (CEA) levels. Conventional imaging, including contrast-enhanced CT of the chest, abdomen and pelvis and standard-time 18F-FDG PET/CT, was negative. However, delayed PET/CT imaging (at 120 minutes) revealed a solitary metabolically active hepatic lesion with Maximum Standardized Uptake Value (SUVmax) 7.6, prompting further evaluation. Core biopsy identified the lesion as large cell neuroendocrine carcinoma (LCNEC) of breast origin, WHO grade 3. This case underscores the diagnostic value of delayed-phase 18F-FDG PET/CT in uncovering metabolically active occult liver metastasis from breast cancer, in those with biochemical recurrence and negative diagnostic imaging modalities including routine 18F-FDG PT/CT. Delayed imaging in dual time point 18F-FDG PET/CT detected a hepatic focal lesion guiding further lesion assessment by biopsy that properly characterized the lesion to have neuroendocrine differentiation, and directed further proper management achieving the concept of precision medicine.
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The data presented in this study are not publicly available due to institutional policies but are available on request from the corresponding author, MHM.
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Copyright (c) 2026 Dr. Mohamed Hossameldin Mustafa, Dr. Moumen Taha Katamesh, Dr. Yousry Wasif Nada, Dr. Batool Essa Albalooshi, Prof. Dr. Mohamad Mosaad ELLabban, MD, Dr. Mohamed Ali Elbeltagy, Prof. Dr. Sherin Wagih Yassin, Prof. Dr. Raafat Ali Saber, MD
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