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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 100-102

Cervical cancer with breast metastasis


1 Division of General Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
2 Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
3 Department of Anatomic Pathology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
4 Department of Obstetrics and Gynecology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan

Date of Submission28-Jun-2018
Date of Decision09-Oct-2018
Date of Acceptance17-Oct-2018
Date of Web Publication31-May-2019

Correspondence Address:
Dr. Chi-Feng Fu
Department of Obstetrics and Gynecology, E-Da Cancer Hospital, No. 21, Yida Road, Jiao-Su Village, Yan-Chao District, Kaohsiung City 824
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCRP.JCRP_14_18

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  Abstract 


Breast metastasis from extramammary solid malignancies is rare, and cervical cancer is an especially uncommon origin. It is clinically challenging to differentiate a primary breast cancer from a metastatic lesion if the patient presents with inflammatory breast skin, axillary lymphadenopathy, and ipsilateral upper-limb lymphedema. Herein, we described the first case of cervical squamous cell carcinoma with breast metastasis presenting as an inflammatory breast lesion in Taiwan. A 41-year-old woman visited our outpatient clinic with edema of bilateral lower legs as well as a reddish left breast and indurated skin. After systemic workup, she was diagnosed as having cervical cancer with peritoneal carcinomatosis and breast and multiple lymph node metastases for which she received palliative chemotherapy. However, bone metastasis developed, and she died 9 months after the diagnosis. We also reviewed relevant literature on breast metastases from an extramammary origin.

Keywords: Breast cancer, breast metastasis, cervical cancer, inflammation


How to cite this article:
Wei CT, Sun CK, Tsai JW, Fu CF. Cervical cancer with breast metastasis. J Cancer Res Pract 2019;6:100-2

How to cite this URL:
Wei CT, Sun CK, Tsai JW, Fu CF. Cervical cancer with breast metastasis. J Cancer Res Pract [serial online] 2019 [cited 2019 Jul 22];6:100-2. Available from: http://www.ejcrp.org/text.asp?2019/6/2/100/259485




  Introduction Top


The most common origin of metastasis to the breast is contralateral breast cancer. The incidence of extramammary malignancies metastasizing to the breast has been reported to be <3% in clinical studies and about 1.7%–6.6% in postmortem autopsy series.[1],[2],[3] The most common site of metastasis of cervical cancer has been reported to be pelvic lymph nodes, followed by para-aortic lymph nodes and distant sites.[4] It is critical to differentiate primary breast cancer from metastatic breast tumors because their management and prognosis are totally different.[5] To date, only a few cases of cervical cancer with breast metastasis have been reported in the English literature.[1],[2],[3],[4],[5] In Taiwan, although a previous study reported a case of cervical cancer with breast metastasis, inflammatory skin presentation of a breast metastatic lesion has not previously been described.[6] Herein, we report a case of cervical cancer with breast metastasis presenting as an inflammatory breast lesion mimicking primary inflammatory breast cancer in Taiwan.


  Case Report Top


A 41-year-old woman presented to our hospital with edema of bilateral lower legs with reddish induration of the skin over her left breast for 1 week. She had no known history of other systemic diseases, previous abdominal trauma, or surgery. Her obstetric and gynecologic history was G1P1AA3, menarche at the age of 18, and a regular menstruation interval (28–30 days). No body weight loss or change in appetite was noted. Physical examination revealed a firm cervical mass, reddish left breast skin with induration, and left upper-limb swelling. Breast sonography demonstrated an ill-defined mass over her left breast >5 cm in size with left axillary and supraclavicular lymphadenopathy [Figure 1]. Mammography of the left breast showed global asymmetry in the subareolar region and significant skin thickening [Figure 2]. A uterine cervix biopsy confirmed the diagnosis of squamous cell carcinoma, whereas biopsies of the left breast mass and left axillary and supraclavicular lymph nodes revealed metastatic carcinoma with features similar to those of endocervical tissues [Figure 3]. The findings of cancer staging workup were suggestive of cervical cancer with peritoneal spread and para-aortic lymphatic invasion. Although she received palliative chemotherapy (cisplatin, fluorouracil, and paclitaxel) after multidisciplinary discussion, lumbar spine metastasis with bone destruction developed. The patient died 9 months after the diagnosis.
Figure 1: Breast ultrasound showing a left breast ill-defined mass and left axillary and left supraclavicular lymphadenopathy

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Figure 2: Mammography demonstrating global asymmetry in the subareolar region and significant skin thickening of the left breast

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Figure 3: (a) Tumor emboli of neoplastic epithelial cells in lymphatic channels in the parenchyma of the left breast, (b) Expression of P40 in tumor cells suggestive of squamous differentiation compatible with metastatic squamous cell carcinoma

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  Discussion Top


It has been reported that metastasis to the breast most commonly originates from contralateral breast cancer. In addition, melanoma, lymphoma, lung cancer, soft-tissue sarcoma, ovarian cancer, and gastrointestinal and genitourinary cancers may also spread to the breast.[1] It is very important to distinguish primary breast cancer from breast metastasis because the treatment strategies are different. While breast surgery can be performed for most early-stage primary breast cancers, palliative therapy has an important role to play in the management of metastatic lesions.[7],[8]

Clinically, breast metastasis from a primary malignancy of nonbreast origin is usually located in the subcutaneous layer of the breast, as blood supply may be better from subcutaneous fat than from breast parenchyma.[9] In our case, metastasis to the breast was through either lymphangitic or hematogenous routes, or both. For lymphangitic spread, the typical sonography features of the breast include diffusely and heterogeneously increased echogenicities in subcutaneous fat and glandular tissue as well as a thick trabecular pattern with skin thickening, lymphedema, and enlarged lymph nodes. On the other hand, the typical sonographic findings of hematogenous spread include single or multiple, round-to-oval-shaped, well-circumscribed hypoechoic masses located superficially in the subcutaneous tissue.[10] Skin thickening, lymphedema, and lymph node involvement were also observed in our case initially.

As more than 60% of metastases to the breast bear histological features suggestive of their origin,[11] a histological diagnosis is mandatory in addition to a detailed clinical history. Morphological assessment is important, and immunohistochemical analysis may be very valuable in identifying the extramammary origin. Therefore, pathological analysis is essential to the identification of the origin of breast metastasis if the histological features are unusual for primary breast cancer.

The treatment of cervical cancer with breast metastasis is mostly palliative chemotherapy with regional control of the breast site. Palliative mastectomy can be considered if surgery can improve the quality of life.[12] The prognosis of breast metastasis is very poor in the presence of several distant metastases, with mortality reported in most patients within 12 months after the diagnosis.[13],[14] For this patient population, supportive care and hospice team involvement may be helpful.


  Conclusion Top


We reported a case of cervical cancer with breast metastasis presenting as an inflammatory breast lesion mimicking primary inflammatory breast cancer. Although breast metastases from extramammary malignancies are rare, it is very important to differentiate them from primary breast cancer because of differences in treatment strategies and prognosis. Detailed clinical history and pathological assessments are crucial and helpful to provide the best treatment for this particular patient population.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Akçay MN. Metastatic disease in the breast. Breast 2002;11:526-8.  Back to cited text no. 1
    
2.
Gupta S, Gupta MK, Gupta R, Mishra RS. Breast metastasis of cervical carcinoma diagnosed by fine needle aspiration cytology. A case report. Acta Cytol 1998;42:959-62.  Back to cited text no. 2
    
3.
Hajdu SI, Urban JA. Cancers metastatic to the breast. Cancer 1972;29:1691-6.  Back to cited text no. 3
    
4.
Waggoner SE. Cervical cancer. Lancet 2003;361:2217-25.  Back to cited text no. 4
    
5.
Mangla A, Agarwal N, Saei Hamedani F, Liu J, Gupta S, Mullane MR. Metastasis of cervical cancer to breast: A case report and review of literature. Gynecol Oncol Rep 2017;21:48-52.  Back to cited text no. 5
    
6.
Yeh CN, Lin CH, Chen MF. Clinical and ultrasonographic characteristics of breast metastases from extramammary malignancies. Am Surg 2004;70:287-90.  Back to cited text no. 6
    
7.
Alqahtani S, Alhefdhi AY, Almalik O, Anwar I, Mahmood R, Mahasin Z, et al. Primary oral malignant melanoma metastasis to the brain and breast: A case report and literature review. Oncol Lett 2017;14:1275-80.  Back to cited text no. 7
    
8.
Moo TA, Sanford R, Dang C, Morrow M. Overview of breast cancer therapy. PET Clin 2018;13:339-54.  Back to cited text no. 8
    
9.
Noguera J, Martínez-Miravete P, Idoate F, Díaz L, Pina L, Zornoza G, et al. Metastases to the breast: A review of 33 cases. Australas Radiol 2007;51:133-8.  Back to cited text no. 9
    
10.
Mun SH, Ko EY, Han BK, Shin JH, Kim SJ, Cho EY. Breast metastases from extramammary malignancies: Typical and atypical ultrasound features. Korean J Radiol 2014;15:20-8.  Back to cited text no. 10
    
11.
Lee AH. The histological diagnosis of metastases to the breast from extramammary malignancies. J Clin Pathol 2007;60:1333-41.  Back to cited text no. 11
    
12.
Yadav P, Manjunath N, Deo S, Shukla N, Durgapal P, Muduly DK. Role of surgery in breast metastasis from carcinoma of the cervix. Indian J Palliat Care 2011;17:74-6.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Moore DH, Wilson DK, Hurteau JA, Look KY, Stehman FB, Sutton GP. Gynecologic cancers metastatic to the breast. J Am Coll Surg 1998;187:178-81.  Back to cited text no. 13
    
14.
Kumar L, Pokharel YH, Dawar R, Thulkar S. Cervical cancer metastatic to the breast: A case report and review of the literature. Clin Oncol (R Coll Radiol) 1999;11:414-6.  Back to cited text no. 14
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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