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Journal of Cancer Research and Therapeutics
Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI)
ISSN: 0973-1482 EISSN: 1998-4138
Vol. 7, Num. 3, 2011, pp. 387-389

Journal of Cancer Research and Therapeutics, Vol. 7, No. 3, July-September, 2011, pp. 387-389

Letter to the Editor - Documenting a Case

Second primary malignancy of breast in a patient of gastrointestinal stromal tumor presenting as fluoro-deoxyglucose-avid breast incidentaloma in fluoro-deoxyglucose-positron emission tomography

Subhash K Ramani1, Sandip Basu2, Vani Parmar3, Sumeet Gujral4, Sandip Bibte3

1 Department of Radiology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
2 Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
3 Department of Surgery, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
4 Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India

Correspondence Address: Sandip Basu, Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai - 400 012, Maharashtra, India, drsanb@yahoo.com

Code Number: cr11102
PMID: 22044838
DOI: 10.4103/0973-1482.87031

Sir,

A second primary in the breast in a patient of gastrointestinal stromal tumor (GIST) is described in this report. This was a serendipitous observation on the whole body flouro-deoxy glucose-positron emission tomography (FDG-PET) study. The patient, a 49-year-old female, an operated case of gastric GIST, underwent FDG-PET for a whole body disease survey and did not show any abnormal disease focus except for an intense (SUVmax 4.3) focus in the left breast [Figure - 1]. The patient underwent mammography and guided biopsy to correlate this incidentally detected FDG-avid focus in the breast [Figure - 2]. The final histopathology turned out to be infiltrating ductal carcinoma grade III [Figure - 3], with triple negative breast carcinoma on immunohistochemistry. Several second primaries in the setting of GIST have been reported in the literature. The present association, to the best of our knowledge, is the first report of breast carcinoma in the setting of GIST.

Synchronous or metachronous second primaries in the setting of GIST have been reported in the literature including that of the non-GI system. [1],[2],[3],[4],[5] There is a solitary report of the association of carcinoma breast and GIST. [2] With the improved patient survival in GIST, reports of its association with other neoplasms are becoming more common. The present case upholds the value of incidental observation in whole body FDG-PET and the fact that disease may be detected when it is confined to the site of primary. Concurrent two different primary malignancies detected by whole body FDG-PET or PET/CT have been described to be of distinct advantage and the present observation of diagnosing this unsuspected second primary malignancy further substantiates this.

References

1.Basu S, Mohandas KM, Peshwe H, Asopa R, Vyawahare M. FDG-PET and PET/CT in the clinical management of gastrointestinal stromal tumor. Nucl Med Commun 2008;29:1026-39.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Schiavon G, Maki RG, Fornier M. GIST and breast cancer: 3 Case reports and a review of the literature. Curr Cancer Ther Rev 2009;5:100-4.  Back to cited text no. 2    
3.Basu S, Nair N, Mohandas KM. FDG-avid thyroid incidentaloma in advanced gastrointestinal stromal tumor: Metachronous dual primaries. Indian J Gastroenterol 2007;26:146-7.  Back to cited text no. 3  [PUBMED]  
4.Lamba M, Verma S, Prokopetz R, Pierscianowski TA, Jabi M, Moyana T. Multiple cutaneous and uterine leiomyomas associated with gastric GIST. J Cutan Med Surg 2005;9:332-5.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Zachaus M, Plotner A, Weimann A, Ruf B. Multiple gastrointestinal stromal tumors in neurofibromatosis type 1. Med Klin (Munich) 2007;102:163-7.  Back to cited text no. 5    

Copyright 2011 - Journal of Cancer Research and Therapeutics

The following images related to this document are available:

Photo images

[cr11102f3.jpg] [cr11102f2.jpg] [cr11102f1.jpg]
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