Cervical and Uterine Metastasis From Carcinoma of Breast Diagnosed by PET/CT

Abstract

A 44-year-old apparently healthy woman presented with a 5-month history of intermittent vaginal bleeding. Clinical examination raised the suspicion of cervical neoplasia which was confirmed to be a metastatic adenocarcinoma on subsequent histopathological evaluation. An F-18 FDG PET/CT scan performed soon after revealed increased uptake in the cervix, extending upwards into the endometrial cavity. Additionally, small FDG avid spiculated soft tissue density masses were visualized in bilateral breast parenchyma, which proved to be lobular carcinoma on sonomammography followed by histopathology. Multiple lytic FDG avid skeletal metastases were also noted. Endometrial biopsy showed infiltrative malignant tumor with cytologic features similar to those observed in the breast biopsy specimen. The entire spectrum of findings pointed to a diagnosis of bilateral lobular carcinoma with uterine, cervical, and skeletal metastasis. Metastasis to the uterus and cervix from a breast primary is extremely rare. Most cases have been diagnosed in the follow-up of known cases of breast carcinoma. Our case is unique in that the patient, who had no prior history of breast carcinoma, was suspected to have a breast primary with cervical and uterine metastasis, based on the PET/CT findings.

Endometrial Metastasis from Ductal Breast Carcinoma: A Case Report with Literature Review

“…A comprehensive literature review performed by Huo et al identified 13 cases of breast metastasis to the endometrium between 1984 and 2015, demonstrating that ER/PR-positive tumors, especially from lobular type (ILC), were more likely to result in endometrial metastasis in comparison to IDC [ 5 , 6 ]. Most of these uterine metastases were detected in known cases of breast cancer patients during their follow-up and hormone therapy period, and in 2016 Cift et al reported a known case of ductal breast carcinoma under tamoxifen therapy who had myometrial metastasis [ 1 , 6 – 8 , 11 , 13 , 14 ]; there was only 1 patient in Delhi who had no prior history of cancer [ 15 ] such as ours, which might be due to poor compliance of cancer screening programs in both countries (India and Iran).…”