Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2014

Open Access 01-12-2014 | Case report

Pancreatic solitary and synchronous metastasis from breast cancer: a case report and systematic review of controversies in diagnosis and treatment

Authors: Carlo Molino, Carmela Mocerino, Antonio Braucci, Ferdinando Riccardi, Martino Trunfio, Giovanna Carrillo, Maria Giuseppa Vitale, Giacomo Cartenì, Guido De Sena

Published in: World Journal of Surgical Oncology | Issue 1/2014

Login to get access

Abstract

Background

Metastases from breast cancer cause the frequent involvement of lung, bone, liver, and brain, while the occurrence of metastases to the gastrointestinal tract is rare, and more frequently discovered after a primary diagnosis of breast cancer. Solitary pancreatic metastases from breast cancer, without widespread disease, are actually unusual, and only 19 cases have been previously described; truly exceptional is a solitary pancreatic metastasis becoming evident together with the primary breast cancer.

Case presentation

A 68-year-old woman reported general fatigue, lethargy, and jaundice. Abdominal ultrasound (US) and magnetic resonance imaging (MRI) showed an ampulloma of Vater’s papilla; moreover, a neoplastic nodule in the left breast was diagnosed. She underwent surgery for both breast cancer and ampulloma of Vater’s papilla. Pathological examination of pancreatic specimen, however, did not confirm primary carcinoma of the duodenal papilla, but showed a metastatic involvement of pancreas from lobular breast cancer. Immunohistochemistry has been essential to confirm the origin of the malignancy: hormone receptors and mammaglobin were expressed in both the primary breast tumor and the pancreatic metastasis.

Conclusions

This is one of the few reported cases in literature of an isolated and synchronous pancreatic metastasis from breast cancer, where the definitive diagnosis was obtained only after surgery. We discuss the controversies in this diagnosis and the choice of correct treatment. The surgical resection of solitary metastases can be performed in the absence of disseminated disease.
Appendix
Available only for authorised users
Literature
1.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ: Cancer statistics 2009. CA Cancer J Clin. 2009, 59: 225-249. 10.3322/caac.20006.CrossRefPubMed
2.
American Cancer Society: Cancer facts and Figures 2012. 2012, New York: American Cancer Society
3.
Dent R, Hanna WM, Trudeau M, Rawlinson E, Sun P, Narod SA: Pattern of metastatic spread in triple-negative breast-cancer. Breast Cancer Res Treat. 2009, 115: 423-428. 10.1007/s10549-008-0086-2.CrossRefPubMed
4.
Ghirarduzzi A, Sivelli R, Martella E, Bella M, De Simone B, Arcuri MF, Zannoni M, Del Rio P, Sianesi M: Gastric metastasis from breast carcinoma. Report of three cases, diagnostic-therapeutic critical close examination and literature review. Ann Ital Chir. 2010, 81: 141-146.PubMed
5.
Lee YT: Breast carcinoma: pattern of metastasis at autopsy. J Surg Oncol. 1983, 23: 175-180. 10.1002/jso.2930230311.CrossRefPubMed
6.
Hiotis SP, Klimstra DS, Conlon KC, Brennan MF: Results after pancreatic resection for metastatic lesions. Ann Surg Oncol. 2002, 7: 675-679.CrossRef
7.
Reddy S, Wolfgang CL: The role of surgery in the management of isolated metastases to the pancreas. Lancet Oncol. 2009, 10: 287-293. 10.1016/S1470-2045(09)70065-8.CrossRefPubMed
8.
Alzahrani MA, Schmulewitz N, Grewal S, Lucas FV, Turner KO, McKenzie JT, Sussman JJ, Ahmad SA: Metastases to the pancreas: the experience of a high volume center and a review of the literature. J Surg Oncol. 2012, 105: 156-161. 10.1002/jso.22009.CrossRefPubMed
9.
Sohn TA, Yeo CJ, Cameron JL, Nakeeb A, Lillemoe KD: Renal cell carcinoma metastatic to the pancreas: results of surgical management. J Gastrointest Surg. 2001, 5: 346-351. 10.1016/S1091-255X(01)80060-3.CrossRefPubMed
10.
Wente MN, Bergmann F, Frohlich BE, Schirmacher P, Buchler MW, Friess H: Pancreatic metastasis from gastric carcinoma: a case report. World J Surg Oncol. 2004, 2: 43-10.1186/1477-7819-2-43.PubMedCentralCrossRefPubMed
11.
Sperti C, Pasquali C, Liessi G, Pinciroli L, Decet G, Pedrazzoli S: Pancreatic resection for metastatic tumors to the pancreas. J Surg Oncol. 2003, 83: 161-166. 10.1002/jso.10262.CrossRefPubMed
12.
Reddy S, Edil BH, Cameron JL, Pawlik TM, Herman JM, Gilson MM, Campbell KA, Schulik RD, Ahuja N, Wolfgang CL: Pancreatic resection of isolated metastases from nonpancreatic primary cancers. Ann Surg Oncol. 2008, 15: 3199-3206. 10.1245/s10434-008-0140-7.CrossRefPubMed
13.
Sweeny AD, Fisher WE, Wu MF, Hilsenbeck SG, Brunicardi FC: Value of pancreatic resection for cancer metastatic to the pancreas. J Surg Res. 2010, 160: 268-276. 10.1016/j.jss.2008.04.012.CrossRef
14.
Abrams HL, Spiro R, Goldstein N: Metastases in carcinoma: analysis of 1000 autopsied cases. Cancer. 1950, 3: 74-85. 10.1002/1097-0142(1950)3:1<74::AID-CNCR2820030111>3.0.CO;2-7.CrossRefPubMed
15.
Akashi Y, Saiura A, Kishi Y, Koga R, Morimura R, Yoshioka R, Yamamoto J, Yamaguchi T: Outcome after surgical resection of isolated metastases to the pancreas. Hepato gastroenterology. 2010, 57: 1549-1552.PubMed
16.
Bonapasta SA, Gregori M, Lanza R, Sangiorgi E, Menghi A, Scarpini M, Modesti M: Metastasis to the pancreas from breast cancer: difficulties in diagnosis and controversies in treatment. Breast Care. 2010, 5: 170-173. 10.1159/000314249.PubMedCentralCrossRefPubMed
17.
Azzarelli A, Clemente C, Quagliuolo V, Baticci F: A case of pancreatoduodenectomy as resolutive treatment for a solitary metastasis of breast cancer. Tumori. 1982, 68: 331-335.PubMed
18.
Bednar F, Scheiman JM, McKenna BJ, Simeone DM: Breast cancer metastases to the pancreas. J Gastrointest Surg. 2013, 17: 1826-1831. 10.1007/s11605-013-2291-5.CrossRefPubMed
19.
Crippa S, Angelini C, Mussi C, Bonardi C, Romano F, Sartori P, Uggeri F, Bovo G: Surgical treatment of metastatic tumors to the pancreas: a single center experience and review of the literature. World J Surg. 2006, 30: 1536-1542. 10.1007/s00268-005-0464-4.CrossRefPubMed
20.
21.
Engel JJ, Trujillo Y, Spellberg M: Metastatic carcinoma of the breast: a cause of obstructive jaundice. Gastroenterology. 1980, 78: 132-135.PubMed
22.
Kitamura N, Murata S, Abe H, Hanasawa K, Tsukashita S, Tani T: Obstructive jaundice in a metastatic tumor of the pancreas from breast cancer: a case report. Jpn J Clin Oncol. 2003, 33: 93-97. 10.1093/jjco/hyg018.CrossRefPubMed
23.
Le Borgne J, Partensky C, Glemain P, Dupas B, de Kerviller B: Pancreaticoduodenectomy for metastatic ampullary and pancreatic tumors. Hepatogastroenterology. 2000, 47: 540-544.PubMed
24.
Mehta SA, Jagannath P, Krishnamurthy SC, De Souza LJ: Isolated pancreatic metastasis from locally controlled breast cancer: a case report. Indian J Cancer. 1991, 28: 48-50.PubMed
25.
Mountney J, Maury AC, Jackson AM, Coleman RE, Johnson AG: Pancreatic metastases from breast cancer: an unusual cause of biliary obstruction. Eur J Surg Oncol. 1997, 23: 574-576. 10.1016/S0748-7983(97)93557-5.CrossRefPubMed
26.
Moussa A, Mitry E, Hammel P, Sauvanet A, Nassif T, Palazzo L, Malka D, Delchier JC, Buffet C, Chaussade S, Aparico T, Lasser P, Rougier P, Lesur G: Pancreatic metastases: a multicentric study of 22 patients. Gastroenterol Clin Biol. 2004, 28: 872-876. 10.1016/S0399-8320(04)95151-2.CrossRefPubMed
27.
Nomizu T, Katagata N, Matsuoka T, Suzuki S, Yabuta T, Watanabe F, Yamaki Y, Saito T, Tsuchiya A, Abe R: A case of breast cancer metastatic to the head of the pancreas. Breast Cancer. 1999, 6: 131-134. 10.1007/BF02966920.CrossRefPubMed
28.
Pan B, Lee Y, Rodriguez T, Lee J, Saif MW: Secondary tumors of the pancreas: a case series. Anticancer Res. 2012, 32: 1449-1452.PubMed
29.
Pappo I, Feigin E, Uziely B, Amir G: Biliary and pancreatic metastases of breast carcinoma: is surgical palliation indicated?. J Surg Oncol. 1991, 46: 211-214. 10.1002/jso.2930460318.CrossRefPubMed
30.
Pérez Ochoa A, Sáez Hernáez F, Cajigas Fernández C, Perez de la Lastra L, Ondiviela Gracia R, Garcia de Polavieja M: Pancreatic metastases from ductal and lobular carcinomas of the breast. Clin Transl Oncol. 2007, 9: 603-605. 10.1007/s12094-007-0110-8.CrossRefPubMed
31.
Tohnosu N, Narushima K, Sunouchi K, Saito T, Shimizu T, Tanaka H, Maruyama T, Watanabe Y, Kato T, Shimizu S, Uehara T, Ishii S: A case of breast cancer metastatic to the tail of the pancreas. Breast Cancer. 2006, 13: 225-229. 10.2325/jbcs.13.225.CrossRefPubMed
32.
Z’graggen K, Fernández-del Castillo C, Rattner DW, Sigala H, Warshaw AL: Metastases to the pancreas and their surgical extirpation. Arch Surg. 1998, 133: 413-417. 10.1001/archsurg.133.4.413.CrossRefPubMed
33.
Mylonas I, Janni W, Friese K, Gerber B: Unexpected metastatic lobular carcinoma of the breast with intraabdominal spread and subsequent port site metastasis after diagnostic laparoscopy for exclusion of ovarian cancer. Gynecol Oncol. 2004, 95: 405-408. 10.1016/j.ygyno.2004.07.057.CrossRefPubMed
34.
Tuech JJ, Pessaux P, Chautard D, Rouge C, Binelli C, Bergamaschi R, Arnaud JP: Results of duodenopancreatectomy for solitary pancreatic metastasis from renal cell carcinoma. J Hepatobiliary Pancreat Surg. 1999, 6: 396-398. 10.1007/s005340050138.CrossRefPubMed
35.
McLemore EC, Pockaj BA, Reynolds C, Gray RJ, Hernandez JL, Grant CS, Donohue JH: Breast cancer: presentation and intervention in women with gastrointestinal metastasis and carcinomatosis. Ann Surg Oncol. 2005, 12: 886-894. 10.1245/ASO.2005.03.030.CrossRefPubMed
36.
Scatarige JC, Horton KM, Sheth S, Fishman EK: Pancreatic parenchymal metastases: observations on helical CT. AJR Am J Roentgenol. 2001, 176: 695-699. 10.2214/ajr.176.3.1760695.CrossRefPubMed
37.
Merkle EM, Boaz T, Kolokythas O, Haaga JR, Lewin JS, Brambs HJ: Metastases to the pancreas. Br J Radiol. 1998, 71: 1208-1214.CrossRefPubMed
38.
Muranaka T, Teshima K, Honda H, Nanjo T, Hanada K, Oshiumi Y: Computed tomography and histologic appearance of pancreatic metastases from distant sources. Acta Radiol. 1989, 30: 615-619. 10.3109/02841858909174725.CrossRefPubMed
39.
Mullady DK, Slivka A: Acute pancreatitis secondary to metastatic lobular breast carcinoma. Report of a case and review of the literature. Pancreas. 2007, 35: 194-196. 10.1097/01.mpa.0000250124.34155.5f.CrossRefPubMed
40.
Schwartz RE, Klimstra DS, Turnbull DM: Metastatic breast cancer masquerading as gastrointestinal primary. Am J Gastroenterol. 1998, 93: 111-114. 10.1111/j.1572-0241.1998.111_c.x.CrossRef
41.
Boudghène FP, Deslandes PM, LeBlanche AF, Bigot JM: US and CT imaging features of intrapancreatic metastases. J Comput Assist Tomogr. 1994, 18: 905-910. 10.1097/00004728-199411000-00010.CrossRefPubMed
42.
D’Onofrio M, Zamboni G, Faccioli N, Capelli P, PozziMucelli R: Ultrasonography of the pancreas. 4. Contrast-enhanced imaging. Abdom Imaging. 2007, 32: 171-181. 10.1007/s00261-006-9010-6.CrossRefPubMed
43.
Kauhanen SP, Komar G, Seppänen MP, Dean KI, Minn HR, Kajander SA, Rinta-Kiikka I, Alanen K, Borra RJ, Puolakkainen PA, Nuutila P, Ovaska JT: A prospective diagnostic accuracy study of18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg. 2009, 250: 957-963. 10.1097/SLA.0b013e3181b2fafa.CrossRefPubMed
44.
Varytimiadis K, Kalaitzakis E, Salla C, Ghika E, Pandazopoulou A, Karoumpalis I: Pancreatic metastasis of thymic neuroendocrine carcinoma: is there a role for endoscopic ultrasound?: report of a case and review of the literature. Pancreas. 2009, 38: 230-232. 10.1097/MPA.0b013e3181816700.CrossRefPubMed
45.
DeWitt J, Jowell P, Leblanc J, McHenry L, McGreevy K, Cramer H, Volmar K, Sherman S, Gress F: EUS-guided FNA of pancreatic metastases: a multicenter experience. Gastrointest Endosc. 2005, 61: 689-696. 10.1016/S0016-5107(05)00287-7.CrossRefPubMed
46.
McIntire M, Siziopikou K, Patil J, Gattuso P: Synchronous metastases to the liver and pancreas from a primary neuroendocrine carcinoma of the breast diagnosed by fine-needle aspiration. Diagn Cytopathol. 2008, 36: 54-57. 10.1002/dc.20753.CrossRefPubMed
47.
Zerbi A, Ortolano E, Balzano G, Borri A, Beneduce AA, Di Carlo V: Pancreatic metastasis from renal cell carcinoma: which patients benefit from surgical resection?. Ann Surg Oncol. 2008, 15: 1161-1168. 10.1245/s10434-007-9782-0.CrossRefPubMed
48.
Minni F, Casadei R, Perenze B, Greco VM, Marrano N, Margiotta A, Marrano D: Pancreatic metastases: observations of three cases and review of the literature. Pancreatology. 2004, 4: 509-520. 10.1159/000080248.CrossRefPubMed
49.
Yamamoto H, Watanabe K, Nagata M, Honda I, Watanabe S, Soda H, Tatezaki S: Surgical treatment for pancreatic metastasis from soft-tissue sarcoma: report of two cases. Am J Clin Oncol. 2001, 24: 198-200. 10.1097/00000421-200104000-00019.CrossRefPubMed
50.
Ascenti G, Visalli C, Genitori A, Certo A, Pitrone A, Mazziotti S: Multiple hypervascular pancreatic metastases from renal cell carcinoma: dynamic MR and spiral CT in three cases. Clin Imaging. 2004, 28: 349-352. 10.1016/S0899-7071(03)00198-0.CrossRefPubMed
51.
Fritscher-Ravens A, Sriram PV, Krause C, Atay Z, Jaeckle S, Thonke F, Brand B, Bohnacker S, Soehendra N: Detection of pancreatic metastases by EUS-guided fine-needle aspiration. Gastrointest Endosc. 2001, 53: 65-70. 10.1067/mge.2001.111771.CrossRefPubMed
52.
Klein KA, Stephens DH, Welch TJ: CT characteristics of metastatic disease of the pancreas. Radiographics. 1998, 18: 369-378. 10.1148/radiographics.18.2.9536484.CrossRefPubMed
53.
Moll R, Mitze M, Frixen UH, Birchmeier W: Differential loss of E-cadherin expression in infiltrating ductal and lobular breast carcinomas. Am J Pathol. 1993, 143: 1731-1742.PubMedCentralPubMed
54.
Goldstein NS, Bassi D, Watts JC, Layfield LJ, Yaziji H, Gown AM: E-cadherin reactivity of 95 noninvasive ductal and lobular lesions of the breast. Implications for the interpretation of problematic lesions. Am J Clin Pathol. 2001, 115: 534-542. 10.1309/B0DD-4M7H-GJG1-7KCW.CrossRefPubMed
55.
Acs G, Lawton TJ, Rebbeck TR, LiVolsi VA, Zhang PJ: Differential expression of E-cadherin in lobular and ductal neoplasms of the breast and its biologic and diagnostic implications. Am J Clin Pathol. 2001, 115: 85-98. 10.1309/FDHX-L92R-BATQ-2GE0.CrossRefPubMed
56.
Palacios J, Sarrió D, García-Macias MC, Bryant B, Sobel ME, Merino MJ: Frequent E-cadherin gene inactivation by loss of heterozygosity in pleomorphic lobular carcinoma of the breast. Mod Pathol. 2003, 16: 674-678. 10.1097/01.MP.0000073974.42583.F7.CrossRefPubMed
57.
Bratthauer GL, Miettinen M, Tavassoli FA: Cytokeratin immunoreactivity in lobular intraepithelial neoplasia. J Histochem Cytochem. 2003, 51: 1527-1531. 10.1177/002215540305101112.PubMedCentralCrossRefPubMed
58.
Bratthauer GL, Moinfar F, Stamatakos MD, Mezzetti TP, Shekitka KM, Man YG, Tavassoli FA: Combined E-cadherin and high molecular weight cytokeratin immunoprofile differentiates lobular, ductal, and hybrid mammary intraepithelial neoplasias. Hum Pathol. 2002, 33: 620-627. 10.1053/hupa.2002.124789.CrossRefPubMed
59.
Lacroix-Triki M, Mery E, Voigt JJ, Istier L, Rochaix P: Value of cytokeratin 5/6 immunostaining using D5/16 B4 antibody in the spectrum of proliferative intraepithelial lesions of the breast. A comparative study with 34betaE12 antibody. Virchows Arch. 2003, 442: 548-554.PubMed
60.
Lehr HA, Folpe A, Yaziji H, Kommoss F, Gown AM: Cytokeratin 8 immunostaining pattern and E-cadherin expression distinguish lobular from ductal breast carcinoma. Am J Clin Pathol. 2000, 114: 190-196. 10.1309/CPUX-KWEH-7B26-YE19.CrossRefPubMed
61.
Nadji M, Gomez-Fernandez C, Ganjei-Azar P, Morales AR: Immunohistochemistry of estrogen and progesterone receptors reconsidered: experiences with 5,993 breast cancers. Am J Clin Pathol. 2005, 123: 21-27. 10.1309/4WV79N2GHJ3X1841.CrossRefPubMed
62.
Waston MA, Fleming TP: Mammaglobin, a mammary-specific member of the uteroglobin gene family, is overexpressed in human breast cancer. Cancer Res. 1996, 56: 860-865.
63.
Miele L, Cordella-Miele E, Mantile G, Peri A, Mukherjee AB: Uteroglobin and uteroglobin-like proteins: the uteroglobin family of proteins. J Endocrinol Invest. 1994, 17: 679-692.CrossRefPubMed
64.
Grünewald K, Haun M, Fiegl M, Urbanek M, Muller-Holzner E, Massoner A, Riha K, Propst A, Marth C, Gastl G: Mammaglobin expression in gynecologic malignancies and malignant effusions detected by nested reverse transcriptase-polymerase chain reaction. Lab Invest. 2002, 82: 1147-1153. 10.1097/01.LAB.0000027840.16064.8A.CrossRefPubMed
65.
Min CJ, Tafra L, Verbanac KM: Identification of superior markers for polymerase chain reaction detection of breast cancer metastases in sentinel lymph nodes. Cancer Res. 1998, 58: 4581-4584.PubMed
66.
Waston MA, Fleming TP: Isolation of differentially expressed sequence tags from human breast cancer. Cancer Res. 1994, 54: 4598-4602.
67.
Amir E, Clemons M, Purdie CA, Miller N, Quinlan P, Geddie W, Coleman RE, Freedman OC, Jordan LB, Thompson AM: Tissue confirmation of disease recurrence in breast cancer patients: pooled analysis of multi-centre, multi-disciplinary prospective studies. Cancer Treat Rev. 2012, 38: 708-714. 10.1016/j.ctrv.2011.11.006.CrossRefPubMed
68.
Stockler M, Wilcken NR, Ghersi D, Simes RJ: Systematic reviews of chemotherapy and endocrine therapy in metastatic breast cancer. Cancer Treat Rev. 2000, 26: 151-168. 10.1053/ctrv.1999.0161.CrossRefPubMed
69.
Osoba D: Health-related quality of life as a treatment endpoint in metastatic breast cancer. Can J Oncol. 1995, Suppl 1: 47-53.
70.
Geels P, Eisenhauer E, Bezjak A, Zee B, Day A: Palliative effect of chemotherapy: objective tumor response is associated with symptom improvement in patients with metastatic breast cancer. J Clin Oncol. 2000, 18: 2395-2405.PubMed
71.
Medina-Franco H, Halpern NB, Aldrete JS: Pancreaticoduodenectomy for metastatic tumors to the periampullary region. J Gastrointest Surg. 1999, 3: 119-122. 10.1016/S1091-255X(99)80019-5.CrossRefPubMed
72.
Niedergethmann M, Richter A, Wendl K, Schmidt B, Post S, Trede M: Rare indications for Kaush-Whipple procedure. Eur J Surg. 2001, 167: 115-119. 10.1080/110241501750070565.CrossRefPubMed
73.
Konstantinidis IT, Dursun A, Zheng H, Wargo JA, Thayer SP, Fernandez-del Castillo C, Warshaw AL, Ferrone CR: Metastatic tumors in the pancreas in the Modern Era. J Am Coll Surg. 2010, 211: 749-753. 10.1016/j.jamcollsurg.2010.08.017.PubMedCentralCrossRefPubMed
Metadata
Title
Pancreatic solitary and synchronous metastasis from breast cancer: a case report and systematic review of controversies in diagnosis and treatment
Authors
Carlo Molino
Carmela Mocerino
Antonio Braucci
Ferdinando Riccardi
Martino Trunfio
Giovanna Carrillo
Maria Giuseppa Vitale
Giacomo Cartenì
Guido De Sena
Publication date
01-12-2014
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2014
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-12-2

Other articles of this Issue 1/2014

World Journal of Surgical Oncology 1/2014 Go to the issue

Research

High p-Smad2 expression in stromal fibroblasts predicts poor survival in patients with clinical stage I to IIIA non-small cell lung cancer

Research

Differential expression of p42.3 in low- and high-grade gliomas

Research

Comparison of hand-sewn and stapled anastomoses in surgeries of gastrointestinal tumors based on clinical practice of China

Research

Surgical resection and outcome of pancreatic cystic neoplasms in China: analysis of a 16-year experience from a single high-volume academic institution

Research

Difference in prognostic values of maximal standardized uptake value on fluorodeoxyglucose-positron emission tomography and cyclooxygenase-2 expression between lung adenocarcinoma and squamous cell carcinoma

Case report

FDG-PET/CT of schwannomas arising in the brachial plexus mimicking lymph node metastasis: report of two cases