Zusammenfassung
Brustmetastasen solider extramammärer Tumoren sind im Vergleich zu primären Malignomen der Brust mit einer Prävalenz von 0,33–6,3 % aller bösartigen Neubildungen in der Brust sehr selten. Die häufigsten Primärtumoren sind dabei das maligne Melanom, ferner Sarkome, Bronchial-, Ovarial-, Nierenzell- und Schilddrüsenkarzinome mit einer absteigenden Häufigkeit ihres Auftretens. In dieser Übersichtsarbeit werden die klinischen Merkmale und die unterschiedlichen Bildgebungsbefunde intramammärer Metastasen solider extramammärer Tumoren aufgezeigt.
Brustmetastasen werden häufig zufällig in Zusammenhang mit einer Computertomographie (CT) oder Positronenemissionstomographie-Computertomographie (PET-CT) entdeckt. Mammographisch weisen Brustmetastasen 2 unterschiedliche bildgebende Erscheinungsmuster im Sinne von Herdbefunden oder aber einer Architekturstörung mit Kutisverdickung auf. Diese kommen in der Regel als solitäre, seltener als multiple runde Herdbefunde mit glatter Randbegrenzung zur Darstellung. Assoziierter Mikrokalk tritt selten auf. Eine diffuse Architekturstörung mit Kutisverdickung kommt gehäuft bei Brustmetastasen der meisten Magenkarzinome, Ovarialkarzinome und Rhabdomyosarkome vor. Sonographisch stellen sich die Befunde hypoechogen, oval oder rund mit glatter Randbegrenzung und dorsaler Schallverstärkung dar. Die MR-Kriterien bei Brustmetastasen sind dagegen inkonstant und können nicht sicher als benigne oder maligne klassifiziert werden. Die erhobenen radiologischen Befunde imponieren hierbei eher benigne, sodass bei bekannter Malignomerkrankung stets an das Vorliegen von Brustmetastasen gedacht werden sollte.
Abstract
Breast metastases of solid extramammary tumors are very rare in comparison to primary malignancies of the breast and account for only 0.33–6.3% of all malignant neoplasms of the breast. The most common primary tumors are malignant melanoma, distant sarcomas, lung cancer, ovarian cancer, renal cell cancer and thyroid cancer in decreasing order of frequency. This review article summarizes the clinical features and the different imaging findings of breast metastases from different extramammary solid tumors. Breast metastases are often incidental findings in computed tomography (CT) or positron emission tomography CT (PET-CT) imaging. Mammography shows two different imaging patterns, namely focal lesions and diffuse architectural distortion with skin thickening. Breast metastases presenting as focal masses usually occur as solitary and more rarely as multiple round lesions with a smooth edge boundary. Associated calcifications are rare findings. Diffuse architectural distortion with skin thickening is more common in breast metastases from most gastric tumors, ovarian cancer and rhabdomyosarcoma. Using ultrasound most lesions are hypoechoic, oval or round with smooth boundaries and posterior acoustic enhancement. The magnetic resonance imaging (MRI) criteria of breast metastases show an inconstant signal behavior that cannot be safely classified as benign or malignant. In summary, in patients with known malignancies the presence of breast metastases should be considered even with imposing clinically and radiologically benign findings.
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S. Wienbeck, S. Nemat, J. Lotz und A. Surov geben an, dass kein Interessenkonflikt besteht.
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Wienbeck, S., Nemat, S., Lotz, J. et al. Bildgebende Diagnostik bei Brustmetastasen extramammärer Tumoren. Radiologe 57, 459–465 (2017). https://doi.org/10.1007/s00117-017-0247-6
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DOI: https://doi.org/10.1007/s00117-017-0247-6