Investig Magn Reson Imaging.  2018 Dec;22(4):245-248. 10.13104/imri.2018.22.4.245.

Contralateral Internal Mammary Lymphadenopathy Mimicking Metastasis in a Patient with a History of Breast Cancer and Prior Interstitial Mammoplasty by Paraffin Injection: MRI, PET-CT, and Pathological Findings

• Nam KJ
• Choo KS
• Kim JY

• KMID: 2431109
• DOI: http://doi.org/10.13104/imri.2018.22.4.245

Abstract

Foreign body injections into breasts may produce foreign body reactions, fibrosis, and local swelling of involved lymph nodes, which can be misdiagnosed as metastasis or malignancy. Here, the authors report MR imaging, PET-CT imaging, and pathologic findings of contralateral internal mammary lymphadenopathy suspicious of breast cancer metastasis in a 58-year-old woman with history of left breast cancer, and previous interstitial mammoplasty by paraffin injection in both breasts.

Keyword

Paraffin; Lymphadenopathy; Internal mammary lymph nodes; Breast cancer metastasis; Magnetic resonance imaging (MRI); Positron emission tomography-computed tomography (PET-CT)

MeSH Terms

Breast Neoplasms*
Breast*
Female
Fibrosis
Foreign Bodies
Humans
Lymph Nodes
Lymphatic Diseases*
Magnetic Resonance Imaging*
Mammaplasty*
Middle Aged
Neoplasm Metastasis*
Paraffin*
Paraffin

Figure

• 

  Fig. 1 A 58-year-old woman with history of left breast cancer, and previous interstitial mammoplasty via paraffin injection in both breasts. (a, b) Axial contrast-enhanced T1-weighted breast MR images showing two enlarged lymph nodes (0.8-cm and 1.0-cm) at the right first, and third intercostal spaces (arrows). (c) Axial PET-CT image showing increased FDG uptake, confined to the same right internal mammary lymph nodes (arrow). (d) Pre-operative axial PET-CT image at the same anatomical level as in (c) showing no FDG uptake. (e) Photomicrograph of histopathological specimen showing drained lipoid droplets, into the lymph node. Multiple empty spaces show a relatively thick and fibrotic wall (arrow). Macrophages with microvesicles, are also dispersed in the lymph node (arrowhead) (Hematoxylin & Eosin staining, × 400). (f) Photomicrograph of histopathological specimen, showing refractile material in empty cystic spaces (arrow) (Hematoxylin & Eosin staining, × 400).

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