INTERESTING IMAGE PET-CT Demonstration of Extensive Muscle Metastases From Breast Cancer Yiyan Liu, MD,* Nasrin Ghesani, MD,* Neena Mirani, MD,† and Lionel S. Zuckier, MD* Abstract: Distant hematogenous spread of metastases to muscle is a distinctly uncommon manifestation of malignancy. With respect to breast cancer, occasional reports of solitary muscle metastases have appeared, although diffuse metastases to muscle is distinctly uncom- mon. We report an 83-year-old woman with breast cancer previously diagnosed and treated 27 years earlier who presented with decreased vision and extraocular muscle palsies. MRI showed nodular thick- ening of the orbital muscles and biopsy confirmed metastasis from breast cancer. Subsequent PET-CT demonstrated extensive foci of increased F-18 fluorodeoxyglucose (FDG) uptake in muscle and bones throughout the body consistent with metastases. Of interest, the patient had undergone bilateral hip replacement for degenerative disease 1 year previously; pathologic review of the previously resected femoral bone sample revealed no evidence of metastasis at that time. Key Words: FDG PET-CT, breast cancer, muscle metastasis (Clin Nucl Med 2006;31: 266 –268) REFERENCES 1. Bullock JD, Yanes B. Ophthalmic manifestations of metastatic breast cancer. Ophthalmology. 1980;87:961–973. 2. Wood CM. Breast cancer—should ophthalmologists now be involved in screening? Eye. 2004;18:1–2. 3. Fenton S, Kemp EG, Harnett AN. Screening for ophthalmic involvement in asymptomatic patients with metastatic breast carcinoma. Eye. 2004;18: 38 – 40. 4. Kuroi K, Tominaga T. Metastasis of breast carcinoma to rectus abdominis muscle. Breast J. 2003;9:58 –59. 5. Wu G, Bybel B, Brunken R, et al. PET detection of solitary distant skeletal muscle metastasis of esophageal adenocarcinoma. Clin Nucl Med. 2005;30:335–337. 6. Baser S, Fisekci FE, Bir F, et al. Rhomboideus major muscle metastasis as an initial clinical manifestation of pulmonary adenocarcinoma. Thorax. 2004;59:728. 7. Di Giorgio A, Sammartino P, Cardini CL, et al. Lung cancer and skeletal muscle metastasis. Ann Thorac Surg. 2004;78:709 –711. 8. Taira H, Ishii T, Inoue Y, et al. Solitary psoas muscle metastasis after radical nephrectomy for renal cell carcinoma. Int J Urol. 2005;12: 96 –97. Received for publication June 23, 2005; accepted December 11, 2005. From the *Section of Nuclear Medicine, Department of Radiology and the †Department of Pathology, New Jersey Medical School, UMDNJ, New- ark, NJ. Reprints: Yiyan Liu, MD, Nuclear Medicine, H-141, University Hospital, 150 Bergen Street, Newark, NJ 07101. E-mail: liuyl@umdnj.edu. Copyright © 2006 by Lippincott Williams & Wilkins ISSN: 0363-9762/06/3105-0266 Clinical Nuclear Medicine • Volume 31, Number 5, May 2006 266