A case of 51-year-old woman with suspected cardiac, pulmonary, bone and renal triple-negative breast cancer metastasis

A case of 51-year-old woman with suspected cardiac, pulmonary, bone and renal triple-negative breast cancer metastasis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A case of 51-year-old woman with suspected cardiac, pulmonary, bone and renal triple-negative breast cancer metastasis Flavia Nicoli, Elona Collaku, Rocco Mollace, Maria Lo Monaco, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9087710/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Introduction . Cardiac magnetic resonance [CMR] represents in literature the gold standard tool for tissue characterization and mass evaluation. The following case highlights the importance of multimodality imaging for the cancer follow-up, in particular for Triple-negative breast cancer whit its increased malignancy and mortality and more aggressive clinical course. This is a case of an unusual manifestation of breast cancer recurrency within the LV and RV apex, not discovered at usual follow-up with X-Ray end echocardiography. Case summary . A 51-year-old woman known for previous triple-negative breast cancer was directed to our Cardiovascular Imaging Department for echocardiographic suspicion of LV cardiac mass. The cardiac magnetic resonance revealed a left ventricle apex roundish mass and an RVOT mass with intracavitary grouth. They appeared to be dishomogenous and vacuolated, with mild and disomogeneous enhancement in the periphery and central regions suspected for hemorrhagic necrotic areas. Extra-cardiac findings revealed pulmonary and vertebral bodies masses, and hypointense lesions in the left kidney. All the reported tissue characteristics were supporting a malignant nature of cardiac and visceral masses, suggestive for breast cancer metastasis. A pulmonary biopsy was consistent for breast origin of the masses. Chemotherapy was performed, but the patient died after two months from the diagnosis. Discussion, Conclusion and Take Home Messages . Triple-negative breast cancer commonly occurs in young women and it’s associated with increased malignancy and mortality, more aggressive clinical course. An increased likelihood of distant recurrence may lead to death, leading to the importance of treatment’s efficiency monitoring with a strict follow-up. cardiac magnetic resonance cancer imaging MR sequences left ventricle Figures Figure 1 Take Home Messages • Cardiac magnetic resonance represents in literature the gold standard tool for tissue characterization and mass evaluation. The following case demonstrates the importance of CMR in clinical practice, discovering malignant cardiac and visceral masses in a paucisymptomatic patient with only suspicion of cardiac mass in the left ventricle apex. • This case highlights the importance of multimodality imaging for the cancer follow-up, in particular for Triple-negative breast cancer whit its increased malignancy and mortality and more aggressive clinical course. This is a case of an unusual manifestation of breast cancer recurrency within the LV and RV apex. Introduction Cardiac magnetic resonance [CMR] represents in literature the gold standard tool for tissue characterization and mass evaluation. The following case highlights the importance of multimodality imaging for the cancer follow-up, in particular for Triple-negative breast cancer whit its increased malignancy and mortality and more aggressive clinical course. This is a case of an unusual manifestation of breast cancer recurrency within the LV and RV apex, not discovered at usual follow-up with X-Ray end echocardiography. Patient Information A 51-year-old woman known for previous triple-negative breast cancer was directed to our Cardiovascular Imaging Department for recent echocardiographic suspicion of cardiac mass in the left ventricle [LV] apex, performed for cough in the previous three months. She underwent surgery and chemotherapy in 2021 for the cancer, no available documentation of the medical history. The follow-up was based only on X-ray and abdomen echography referred to be normal. Physical examination was normal. A LV cancer mass was suspected due to cancer history. The differential diagnosis with thrombus was the main reason for CMR indication for tissue characterization. The patient was de-identified for case presentation. Clinical findings and diagnostic assessment Cardiac magnetic resonance revealed a LV apex roundish mass with intracavitary grouth, and a right ventricle [RV] mass obstructing the Right Ventricle Outflow Tract [RVOT] [Fig. 1; Video 1-4]. A double-bolus injection was administered to enable the simultaneous study of two masses. The masses appeared dishomogenous-vacuolated in SSFP-b [Panel a], iso/mild hyperintense in T1-w [Panel b] and hyperintense in T2-w sequences [Panel c], with dishomogenous aspect in central regions and hypointense hemorrhagic/necrotic areas. Absence of contrast enhancement in central regions, with mild/disomogeneous enhancement in the periphery were observed in first pass images [Panel d], post-contrast T1-w [Panel e] and LGE sequences [Panel f]. Normal volume/function of LV and RV were detected (LVEF 60%, RVEF 61%), in absence of myocardial LGE. A mild diffuse elevation of T2-mapping values in LV was seen (55-60 msec, normal value <55 sec), with incremental values into the myocardium nearest the LV apex mass [Panel g, left and middle] and in the RV mass, also characterized by T2-w hyperintesity. A diffuse elevation of T1-mapping values was observed with 1140 msec mid value (normal values range into our Department: 980-1130 msec) and ECV synthetic mild elevation (ECV 30%) [Panel g, right], as for diffuse fibrosis. Extra-cardiac findings [Panel h] revealed a huge pulmonary mass into left superior para-hilar region (dimensions 47 x 46 mm), strictly linked to left pulmonary artery with possible infiltration, and a similar mass into the apical-dorsal segment of the left upper pulmonary lobe (62x43 mm). The most possible diagnosis was breast cancer metastasis, and less probable a primary pulmonary tumor. Other two different masses were founded in dorsal vertebral bodies (dimensions 23 and 29 mm) with suspected pleural infiltrations, and hypointense nodular lesions were detected in the upper two-thirds of the left kidney (15 mm). These last findings were also suspicious for secondary lesions. Therapeutic Intervention, Follow-up and Outcomes The patient was referred from an other hospital to our Imaging Department only for CMR evaluation of a previously suspected mass in the Left Ventricle. After CMR diagnosis, she was immediately referred to her referral hospital for urgent diagnosis and treatment of the two cardiac masses and the huge pulmonary mass suspected for metastasis. No publishing data are available from the other hospital in which she was studied with a total-body CT scan and echocardiogram, which confirmed the CMR findings. A following pulmonary biopsy was consistent for breast origin of the masses. Chemotherapy was performed, but the patient died after two months from the diagnosis. Discussion All the reported tissue characteristics were supporting a malignant nature of cardiac and visceral masses (heterogeneous characteristics at T1-w and T2-w images with dark spots as necrotic/hemorrhagic areas, first pass enhancement and LGE heterogeneity, multiplicity and multi-chamber involvement), suggestive for breast cancer metastasis, although a primary cardiac tumor was not excludible 1,2,3 . The out-of-hospital echocardiogram did not report the RV mass, and the X-ray recently performed did not show pulmonary masses. Cardiac Magnetic Resonance is nowadays the technique offering the clinician the most comprehensive approach to mass evaluation. The high-spatial and temporal resolution, the free choice of image plane and image size, myocardial perfusion assessment and late gadolinium enhancement evaluation give the method the highest value for tissue characterization and differential diagnosis. Conclusions Triple-negative breast cancer commonly occurs in young women and it is associated with increased malignancy and mortality, more aggressive clinical course. An increased likelihood of distant recurrence (mainly brain and visceral in lungs, liver and less frequently bone, with less cases of cardiac metastasis known in literature 4,5 ) may lead to death, leading to the importance of treatment’s efficiency monitoring with a strict follow-up 6,7,8 . Declarations Funding : Authors are grateful to Cliniche Gavazzeni SpA for the financial support of this publication. Disclosures : None Ethical Approval and accordance: The case report publication was approved by Ethical committee of Humanitas Gavazzeni in accordance with the Declaration of Helsinki. the Hospital committee and ethical statement of Humanitas Gavazzeni, Bergamo. No study data were involve, so no need of ethical number (N/A). Consent to partecipate : N/A. This is not a study, the patient signed an informed consent to perform the cardiac magnetic resonance exam. Consent to publish : A consent to publish was obtained. The patient was de-identified. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Acknowledgments The case is dedicated to the patient, who was directed to the reference hospital and followed in the clinical course, and to her family. Authors are grateful to Cliniche Gavazzeni SpA for the financial support of this publication. Informed Consent An informed consent to publish the patient data had been obtained from the patient at the time of cardiac magnetic resonance execution. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. References Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. 2007;60(1):27–34. Pun SC, et al. Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging. J Am Heart Assoc. 2016;5(5):1–9. Ferrari V. The EACVI Textbook of Cardiovascular Magnetic Resonance. Online ed. Oxford University Press; 2018. Dent R, et al. Triple-negative breast cancer: Clinical features and patterns of recurrence. Clin Cancer Res. 2007;13(15):4429–34. Zhu S, et al. Recent advances in targeted strategies for triple-negative breast cancer. J Hematol Oncol. 2023;16(1):1–36. Mallapasi MN, Kusumanegara J, Kabo P, Usman U, Mulyono MT, Faruk M. Cardiac metastasis of triple-negative breast cancer mimicking myxoma: A case report, Int. J. Surg. Case Rep. , vol. 88, no. September, p. 106552, 2021. O’Reilly D, Sendi MA, Kelly CM. Overview of recent advances in metastatic triple negative breast cancer. World J Clin Oncol. 2021;12(3):164–82. Dass SA, et al. Triple negative breast cancer: A review of present and future diagnostic modalities. Med. 2021;57(1):1–18. Additional Declarations No competing interests reported. Supplementary Files 1.LVmasscine4chamber.mp4 2.LVmasscinechamber.mp4 3.RVOTmasscine.mp4 4.RVmassfirstpassperfusion.mp4 Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 May, 2026 Reviews received at journal 27 Apr, 2026 Reviews received at journal 26 Apr, 2026 Reviews received at journal 18 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers invited by journal 09 Apr, 2026 Editor invited by journal 31 Mar, 2026 Editor assigned by journal 29 Mar, 2026 Submission checks completed at journal 26 Mar, 2026 First submitted to journal 26 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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20:54:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9087710/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9087710/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107254044,"identity":"3371a116-4404-4a71-880c-f1852c480cb8","added_by":"auto","created_at":"2026-04-19 11:59:45","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":752585,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCardiac magnetic resonance study of left ventricle and right ventricle masses, with tissue characterization at SSFP-b sequences (panel a), T1-w and T2-w images (respectively panel b and c), first pass images (panel d), T1-w 3 minute post-contrast image (panel e), PSIR sequences (panel f), T2-mapping (panel g, at left and the middle) and T1-mapping (panel g, at right). Extracardial findings are represented in panel h: a pulmonary mass strictly linked to left pulmonary artery with possible infiltration (middle), a mass in dorsal vertebral body with suspected pleural infiltrations (left), and hypointense nodular lesions in the upper two-thirds of the left kidney (right).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9087710/v1/d498d49783e6aa70782b5b71.jpeg"},{"id":107486768,"identity":"9fffe972-3054-4e00-84d3-3e83b1467cb1","added_by":"auto","created_at":"2026-04-22 02:38:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":922819,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9087710/v1/5aaa00cc-fc0b-481b-a57a-e9d05fc4eac7.pdf"},{"id":107484588,"identity":"3c31595e-8228-4aa0-89af-459dfef1aa14","added_by":"auto","created_at":"2026-04-22 02:32:26","extension":"mp4","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":381239,"visible":true,"origin":"","legend":"","description":"","filename":"1.LVmasscine4chamber.mp4","url":"https://assets-eu.researchsquare.com/files/rs-9087710/v1/c6b9814989bd223e0f9d44f4.mp4"},{"id":107482901,"identity":"ce4954bb-e9ee-4ddb-b066-d4877a5226cf","added_by":"auto","created_at":"2026-04-22 02:25:25","extension":"mp4","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":420646,"visible":true,"origin":"","legend":"","description":"","filename":"2.LVmasscinechamber.mp4","url":"https://assets-eu.researchsquare.com/files/rs-9087710/v1/e3ee3a6e1a0130da055eeb54.mp4"},{"id":107484142,"identity":"21d4c0f4-9839-413f-94b5-e3e241fc5eeb","added_by":"auto","created_at":"2026-04-22 02:30:56","extension":"mp4","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":1694365,"visible":true,"origin":"","legend":"","description":"","filename":"3.RVOTmasscine.mp4","url":"https://assets-eu.researchsquare.com/files/rs-9087710/v1/105eacc9b969ae6389070068.mp4"},{"id":107254048,"identity":"d93cf14c-57ec-4561-bcdf-4ca02c1ada0b","added_by":"auto","created_at":"2026-04-19 11:59:45","extension":"mp4","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":22042427,"visible":true,"origin":"","legend":"","description":"","filename":"4.RVmassfirstpassperfusion.mp4","url":"https://assets-eu.researchsquare.com/files/rs-9087710/v1/aff1794a23c866b57f0404a1.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"A case of 51-year-old woman with suspected cardiac, pulmonary, bone and renal triple-negative breast cancer metastasis","fulltext":[{"header":"Take Home Messages","content":"\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e• \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Cardiac magnetic resonance represents in literature the gold standard tool for tissue characterization and mass evaluation. The following case demonstrates the importance of CMR in clinical practice, discovering malignant cardiac and visceral masses in a paucisymptomatic patient with only suspicion of cardiac mass in the left ventricle apex.\u003c/p\u003e\u003cp\u003e• \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;This case highlights the importance of multimodality imaging for the cancer follow-up, in particular for Triple-negative breast cancer whit its increased malignancy and mortality and more aggressive clinical course. This is a case of an unusual manifestation of breast cancer recurrency within the LV and RV apex.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eCardiac magnetic resonance [CMR] represents in literature the gold standard tool for tissue characterization and mass evaluation. The following case highlights the importance of multimodality imaging for the cancer follow-up, in particular for Triple-negative breast cancer whit its increased malignancy and mortality and more aggressive clinical course. This is a case of an unusual manifestation of breast cancer recurrency within the LV and RV apex, not discovered at usual follow-up with X-Ray end echocardiography.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 51-year-old woman known for previous triple-negative breast cancer was directed to our Cardiovascular Imaging Department for recent echocardiographic suspicion of cardiac mass in the left ventricle [LV] apex, performed for cough in the previous three months. She underwent surgery and chemotherapy in 2021 for the cancer, no available documentation of the medical history. The follow-up was based only on X-ray and abdomen echography referred to be normal. Physical examination was normal.\u003c/p\u003e\n\u003cp\u003eA LV cancer mass was suspected due to cancer history. The differential diagnosis with thrombus was the main reason for CMR indication for tissue characterization. The patient was de-identified for case presentation.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Clinical findings and diagnostic assessment","content":"\u003cp\u003eCardiac magnetic resonance revealed a LV apex roundish mass with intracavitary grouth, and a right ventricle [RV] mass obstructing the Right Ventricle Outflow Tract [RVOT] [Fig. 1; Video 1-4]. A double-bolus injection was administered to enable the simultaneous study of two masses.\u003c/p\u003e\u003cp\u003eThe masses appeared dishomogenous-vacuolated in SSFP-b [Panel a], iso/mild hyperintense in T1-w [Panel b] and hyperintense in T2-w sequences [Panel c], with dishomogenous aspect in central regions and hypointense hemorrhagic/necrotic areas.\u003c/p\u003e\u003cp\u003eAbsence of contrast enhancement in central regions, with mild/disomogeneous enhancement in the periphery were observed in first pass images [Panel d], post-contrast T1-w [Panel e] and LGE sequences [Panel f]. Normal volume/function of LV and RV were detected (LVEF 60%, RVEF 61%), in absence of myocardial LGE. \u0026nbsp;\u003c/p\u003e\u003cp\u003eA mild diffuse elevation of T2-mapping values in LV was seen (55-60 msec, normal value \u0026lt;55 sec), with incremental values into the myocardium nearest the LV apex mass [Panel g, left and middle] and in the RV mass, also characterized by T2-w hyperintesity. A diffuse elevation of T1-mapping values was observed with 1140 msec mid value (normal values range into our Department: 980-1130 msec) and ECV synthetic mild elevation (ECV 30%) [Panel g, right], as for diffuse fibrosis.\u003c/p\u003e\u003cp\u003eExtra-cardiac findings [Panel h] revealed a huge pulmonary mass into left superior para-hilar region \u0026nbsp;(dimensions 47 x 46 mm), strictly linked to left pulmonary artery with possible infiltration, and a similar mass into the apical-dorsal segment of the left upper pulmonary lobe (62x43 mm). The most possible diagnosis was breast cancer metastasis, and less probable a primary pulmonary tumor. \u0026nbsp;Other two different masses were founded in dorsal vertebral bodies (dimensions 23 and 29 mm) with suspected pleural infiltrations, and hypointense nodular lesions were detected in the upper two-thirds of the left kidney (15 mm). These last findings were also suspicious for secondary lesions.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTherapeutic Intervention, Follow-up and Outcomes\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe patient was referred from an other hospital to our Imaging Department only for CMR evaluation of a previously suspected mass in the Left Ventricle. After CMR diagnosis, she was immediately referred to her referral hospital for urgent diagnosis and treatment of the two cardiac masses and the huge pulmonary mass suspected for metastasis. No publishing data are available from the other hospital in which she was studied with a total-body CT scan and echocardiogram, which confirmed the CMR findings. A following pulmonary biopsy was consistent for breast origin of the masses. Chemotherapy was performed, but the patient died after two months from the diagnosis.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAll the reported tissue characteristics were supporting a malignant nature of cardiac and visceral masses (heterogeneous characteristics at T1-w and T2-w images with dark spots as necrotic/hemorrhagic areas, first pass enhancement and LGE heterogeneity, multiplicity and multi-chamber involvement), suggestive for breast cancer metastasis, although a primary cardiac tumor was not excludible\u003csup\u003e1,2,3\u003c/sup\u003e. The out-of-hospital echocardiogram did not report the RV mass, and the X-ray recently performed did not show pulmonary masses.\u003c/p\u003e\u003cp\u003eCardiac Magnetic Resonance is nowadays the technique offering the clinician the most comprehensive approach to mass evaluation. The high-spatial and temporal resolution, the free choice of image plane and image size, myocardial perfusion assessment and late gadolinium enhancement evaluation give the method the highest value for tissue characterization and differential diagnosis.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTriple-negative breast cancer\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ecommonly occurs in young women and it is associated with increased malignancy and mortality, more aggressive clinical course. An increased likelihood of distant recurrence (mainly brain and visceral in lungs, liver and less frequently bone, with less cases of cardiac metastasis known in literature\u003csup\u003e4,5\u003c/sup\u003e) may lead to death, leading to the importance of \u0026nbsp;treatment’s efficiency monitoring with a strict follow-up\u003csup\u003e6,7,8\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Authors are grateful to Cliniche Gavazzeni SpA for the financial support of this publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosures\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and accordance:\u0026nbsp;\u003c/strong\u003eThe case report publication was approved by Ethical committee of Humanitas Gavazzeni \u0026nbsp;in accordance with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ethe Hospital committee and ethical statement of Humanitas Gavazzeni, Bergamo. No study data were involve, so no need of ethical number (N/A).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to partecipate\u003c/strong\u003e: N/A. This is not a study, the patient signed an informed consent to perform the cardiac magnetic resonance exam.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e: A consent to publish was obtained. The patient was de-identified.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe case is dedicated to the patient, who was directed to the reference hospital and followed in the clinical course, and to her family.\u003c/p\u003e\n\u003cp\u003eAuthors are grateful to Cliniche Gavazzeni SpA for the financial support of this publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed\u003c/strong\u003e \u003cstrong\u003eConsent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn informed consent to publish the patient data had been obtained from the patient at the time of cardiac magnetic resonance execution.\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e \u003cli\u003e\u003cspan\u003eBussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. 2007;60(1):27\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePun SC, et al. Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging. J Am Heart Assoc. 2016;5(5):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerrari V. The EACVI Textbook of Cardiovascular Magnetic Resonance. Online ed. Oxford University Press; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDent R, et al. Triple-negative breast cancer: Clinical features and patterns of recurrence. Clin Cancer Res. 2007;13(15):4429\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu S, et al. Recent advances in targeted strategies for triple-negative breast cancer. J Hematol Oncol. 2023;16(1):1\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMallapasi MN, Kusumanegara J, Kabo P, Usman U, Mulyono MT, Faruk M. Cardiac metastasis of triple-negative breast cancer mimicking myxoma: A case report, \u003cem\u003eInt. J. Surg. Case Rep.\u003c/em\u003e, vol. 88, no. September, p. 106552, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Reilly D, Sendi MA, Kelly CM. Overview of recent advances in metastatic triple negative breast cancer. World J Clin Oncol. 2021;12(3):164\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDass SA, et al. Triple negative breast cancer: A review of present and future diagnostic modalities. Med. 2021;57(1):1\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cardiac magnetic resonance, cancer, imaging, MR sequences, left ventricle","lastPublishedDoi":"10.21203/rs.3.rs-9087710/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9087710/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eIntroduction\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eCardiac magnetic resonance [CMR] represents in literature the gold standard tool for tissue characterization and mass evaluation. The following case highlights the importance of multimodality imaging for the cancer follow-up, in particular for Triple-negative breast cancer whit its increased malignancy and mortality and more aggressive clinical course. This is a case of an unusual manifestation of breast cancer recurrency within the LV and RV apex, not discovered at usual follow-up with X-Ray end echocardiography.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCase summary\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eA 51-year-old woman known for previous triple-negative breast cancer was directed to our Cardiovascular Imaging Department for echocardiographic suspicion of LV cardiac mass.\u003c/p\u003e\n\u003cp\u003eThe cardiac magnetic resonance revealed a left ventricle apex roundish mass and an RVOT mass with intracavitary grouth. They appeared to be dishomogenous and vacuolated, with mild and disomogeneous enhancement in the periphery and central regions suspected for hemorrhagic necrotic areas. Extra-cardiac findings revealed pulmonary and vertebral bodies masses, and hypointense lesions in the left kidney. All the reported tissue characteristics were supporting a malignant nature of cardiac and visceral masses, suggestive for breast cancer metastasis.\u003c/p\u003e\n\u003cp\u003eA pulmonary biopsy was consistent for breast origin of the masses. Chemotherapy was performed, but the patient died after two months from the diagnosis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDiscussion, Conclusion and Take Home Messages\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eTriple-negative breast cancer\u003cstrong\u003e \u003c/strong\u003ecommonly occurs in young women and it’s associated with increased malignancy and mortality, more aggressive clinical course. An increased likelihood of distant recurrence may lead to death, leading to the importance of \u0026nbsp;treatment’s efficiency monitoring with a strict follow-up.\u003c/p\u003e","manuscriptTitle":"A case of 51-year-old woman with suspected cardiac, pulmonary, bone and renal triple-negative breast cancer metastasis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 11:59:40","doi":"10.21203/rs.3.rs-9087710/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-08T11:40:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-27T10:33:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-26T21:47:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-18T06:09:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172802894770157786488352278992676330840","date":"2026-04-17T17:05:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237458113711271973652144694852312320502","date":"2026-04-15T21:39:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122300825576362007979110049307088019299","date":"2026-04-15T19:58:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-09T04:56:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-31T07:12:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-29T18:00:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-26T21:17:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Medicine","date":"2026-03-26T21:14:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"07473f21-8bb5-4b80-a888-588aaeeb5700","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-08T11:40:17+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T15:23:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 11:59:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9087710","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9087710","identity":"rs-9087710","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}