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Metastatic carcinoma of the breast: the appearances of metastatic spread to the abdomen and pelvis as demonstrated by CT

¹ Department of Radiology, St George's Hospital, Blackshaw Road, London SW17 0QT, ² Academic Department of Diagnostic Radiology, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK

View larger version (150K): [in this window] [in a new window]   Figure 1. There are bulky low attenuation masses in the liver. They are centrally of low attenuation with some uptake of contrast at the periphery.

View larger version (66K): [in this window] [in a new window]   Figure 2. "Pseudocirrhosis" in a patient 3 years after diagnosis of breast cancer. (a) Contrast-enhanced CT demonstrates a non-enlarged liver with mixed attenuation nodules, irregular outline and ascites. (b) Ultrasound reveals diffusely echogenic pattern without obvious discrete masses. The appearance was entirely stable on imaging over an 8 month interval, at which time the clinician insisted on a biopsy which revealed metastatic breast cancer.

View larger version (145K): [in this window] [in a new window]   Figure 3. CT of liver shows knobbly outline, diffuse nodularity and ascites. This pseudocirrhotic appearance is a fairly common manifestation of metastatic breast carcinoma.

View larger version (143K): [in this window] [in a new window]   Figure 4. The background liver parenchyma has low attenuation as a result of diffuse fat infiltration. In addition there are several metastatic deposits that are seen as irregular masses of low attenuation, with a periphery that enhances avidly after the administration of intravenous contrast. Development of fatty change while on treatment can increase conspicuity of the enhancing rim simulating enlargement of lesions which are stable in size.

View larger version (152K): [in this window] [in a new window]   Figure 5. A small area of focal fatty change is seen in segment 4b of the liver, adjacent to the falciform ligament(arrow). The liver architecture is normal, and no other abnormalities were seen within the liver. This appearance should not be misinterpreted as metastatic disease.

View larger version (135K): [in this window] [in a new window]   Figure 6. There is a solitary round area of low attenuation within the spleen that was not present on earlier imaging and signifies a metastasis.

View larger version (144K): [in this window] [in a new window]   Figure 7. The spleen is enlarged and contains numerous ill-defined metastases, which have similar characteristics to those within the liver.

View larger version (172K): [in this window] [in a new window]   Figure 8. A 25 mm x 15 mm metastasis is present in the right adrenal gland, distorting the normal morphology.

View larger version (145K): [in this window] [in a new window]   Figure 9. An enlarged retrocrural node measuring 9 mm in short axis is seen adjacent to the aorta (arrow) and represents a site of metastatic infiltration.

View larger version (136K): [in this window] [in a new window]   Figure 10. There are several lymph nodes measuring up to 15 mm in the retroperitoneum that are encircling the aorta and inferior vena cava.

View larger version (143K): [in this window] [in a new window]   Figure 11. Two discrete mesenteric nodes(arrow) are visible measuring up to 12 mm in short axis, in a patient with widely disseminated disease.

View larger version (125K): [in this window] [in a new window]   Figure 12. There are no discrete nodal mass lesions but there is retroperitoneal fat stranding(arrow) which can indicate infiltration by metastatic breast cancer of retroperitoneal (and mediastinal) fat. Note also the left hydronephrosis as a result of malignant retroperitoneal fibrosis.

View larger version (110K): [in this window] [in a new window]   Figure 13. 3D CT sagittal reformat of lower thoracic and lumbar spine: sclerotic metastases are seen within the bodies of the T12 and L1 vertebrae. There is loss of height of the L1 vertebral body and posterior displacement of bone into the spinal canal.

View larger version (92K): [in this window] [in a new window]   Figure 14. (a) Axial view at the level of L4 using soft tissue windows. A soft tissue mass (black arrow) is seen to arise from the posterior aspect of the vertebral body and is compressing the cauda equina. There is also a deposit in the right psoas (white arrow) causing asymmetry of the muscles. (b) Bone windows demonstrated a destructive metastasis affecting the vertebral body and posterior elements.

View larger version (109K): [in this window] [in a new window]   Figure 15. A purely lytic metastasis has eroded the left pedicle of L1, but there is no associated soft tissue mass.

View larger version (121K): [in this window] [in a new window]   Figure 16. A deposit causing sclerosis is seen within the vertebral body whilst the metastasis in the right iliac blade has eroded the bone with a lytic appearance.

View larger version (150K): [in this window] [in a new window]   Figure 17. Diffuse, ill-defined nodularity and stranding is seen within the omental fat (arrows), a characteristic appearance of peritoneal deposits.

View larger version (120K): [in this window] [in a new window]   Figure 18. In a patient with known metastatic breast cancer presenting with vomiting, a mass lesion in the duodenum is demonstrated(arrows). Endoscopy showed a mural mass and biopsy confirmed metastatic breast carcinoma.

View larger version (162K): [in this window] [in a new window]   Figure 19. Several low attenuation metastases(black arrow) are seen in the cortex of both kidneys. They have no clear margins and are expansile. The attenuation is higher than that of fluid within the gallbladder and hence they are not simple renal cysts. Note also hepatic metastatic disease (white arrow). Hepatic lesions were of similar attenuation and morphology to renal deposits and a presumptive diagnosis was made from the imaging features.

View larger version (154K): [in this window] [in a new window]   Figure 20. Bladder wall is irregularly thickened in this patient who had metastases in numerous other sites throughout the pelvis. Urine cytology was positive for the presence of malignant cells, metastatic from breast cancer.

View larger version (146K): [in this window] [in a new window]   Figure 21. A 4.5 cm adnexal mass, an ovarian deposit of breast cancer, with an irregular convex anterior border is seen to indent the posterior aspect of the bladder.

View larger version (165K): [in this window] [in a new window]   Figure 22. A 21 mm nodule is seen arising from the umbilicus (arrow).