Metastasis from apocrine carcinoma of the breast to an endometrial polyp

Abstract

Sirs,It is not unusual for extra-genital neoplasms to metastasise to the female genital. However, the metastases are localised mainly in the ovary and vagina and rarely in the uterus. Metastasis of extra-genital tract neoplasms to an endometrial polyp has been described only twice; both cases concerned breast carcinomas, one of lobular type [1] and one of ductal type [7]. We would like to report the first observation of metastasis from an apocrine carcinoma of the breast to an endometrial tamoxifeninduced polyp.The patient was a 70-year-old woman who presented with a 1-month history of metrorrhagia. The patient had, 4 years previously, undergone total left breast mastectomy with ipsilateral axillary lymphadenectomy for an infiltrating apocrine breast carcinoma. The tumour was 20×10×10 mm in size with evidence of metastatic involvement of one axillary lymph node and was, therefore, reported as pT1cN1 in accordance with the 1997 International Union Against Cancer (UICC) staging of breast tumours. Complementary studies, including chest X-ray, hepatic ultrasonography and bone isotopic scan were all negative. Post-surgery treatment consisted of radiotherapy and tamoxifen therapy, although the tumour showed only focal and weak positivity for oestrogen receptors. Follow-up was uneventful for 4 years. However, 4 years later, the patient complained of recurrent metrorrhagia. She underwent hysteroscopy with curettage and abdominal ultrasound. The latter revealed a polypoid mass 1.5 cm in length appended to the uterine dome. Total abdominal hysterectomy with bilateral salpingooophorectomy was performed.Gross examination of the uterus confirmed the presence of a polypoid mass 1.5×1.0×0.5 cm in size attached to the uterine dome. Cervix, myometrium and annexes were grossly unremarkable. The microscopical features of the polyp were typical of those induced by tamoxifen therapy. They showed sparse, irregularly scattered, focally dilated glands, lined by either atrophic or proliferative epithelium. The stroma was diffusely fibrotic with thick-walled, dilated blood vessels. Clusters of large eosinophilic cells similar to those observed in the primary breast carcinoma with abundant granular cytoplasm, globoid nuclei and prominent nucleoli, were visible within the polyp stroma (Fig. 1). In addition, numerous vascular emboli from the same eosinophilic cells were also visible. Immunohistochemically, the tumour cells showed strong positivity for AE1 and AE3 cytokeratins, epithelial membrane antigen (EMA) and GCDFP-15 (Fig. 2). In contrast, oestrogen and progesterone receptors were negative. No other microscopic metastases were found in the adjacent endometrium, myometrium, ovaries, tubes or cervix.

Metastatic Breast Lobular Carcinoma Involving Tamoxifen-Associated Endometrial Polyps: Report of Two Cases and Review of Tamoxifen-Associated Polypoid Uterine Lesions

“…The two cases we report suggest that lobular carcinoma has a particular propensity to involve endometrial polyps, in keeping with the observation that this type of breast carcinoma is most likely to metastasize to the female genital tract. In one of the previously reported cases, the endometrial polyp appears to have been tamoxifen associated (17). It was not stated in the other two reports whether the patients were taking tamoxifen.…”

Breast carcinoma metastasis to endometrial polyp (Case report and literature review)

“…Tamoxifen related polyps are characterized by glandular metaplastic changes and periglandular stromal condensation [6,8], but Manipadam et al [8] also stated that these changes are not unique, in their representation of their case that is unrelated to tamoxifen. The metastatic breast carcinomas to endometrial polyps are presented as case reports in the literature, and the cases are mostly of lobular type [3,5,[6][7][8][9], as well as reported ductal and apocrine types [2,4,10,12,13]. Endometrial pathologies can frequently seen, in the patients followed for breast carcinoma, and pathological examination should be made very carefully, with evaluation of the whole material and serial sections when required, in order not to miss a metastatic foci.…”

“…When there is no involvement of ovaries or myometrium, hematogenous spread should be thought from distant primaries [4,13]. Breast is the most common primary carcinoma seen in uterus followed by, stomach, cutaneous malonoma, lung, colon, pancreas and kidney [1][2][3]. Endometrial involvement, when present, can be a component of diffuse metastasis of a disseminated cancer [11,[14][15][16] and endometrial involvement is usually diffuse sparing the glands [1].…”

“…The route of metastasis is via the lymphatics from the overies, but in the case of isolated endometrial metastasis, hematogenous spread should be thought [4]. The histological type of the primary tumor is mostly lobular carcinoma [5][6][7][8][9], as well as reported ductal, metaplastic, apocrine carcinomas [2,4,[10][11][12][13]. We report a case of metastatic breast carcinoma of invasive ductal type to an endometrial polyp.…”

“…The primary sites of these metastasis are mostly breast, followed by stomach, cutaneous malonoma, lung, colon, pancreas and kidney [1][2][3]. The route of metastasis is via the lymphatics from the overies, but in the case of isolated endometrial metastasis, hematogenous spread should be thought [4].…”