Lokadasan Rajitha, Ratheesan K, Sukumaran Renu, Nair Sindhu P
Department of Medical Oncology, Regional Cancer Centre, Medical College Campus, Post Bag No 2417, Trivandrum 695011, India.
Department of Radiotherapy, Regional Cancer Centre, Trivandrum 695011, India.
Ecancermedicalscience. 2015 Sep 10;9:571. doi: 10.3332/ecancer.2015.571. eCollection 2015.
Invasive lobular carcinoma (ILC) of the breast exhibits unusual clinicopathological, radiological, histological, and metastatic patterns. We present here two cases of ILC of the breast that presented with an unusual pattern of metastasis involving the uterus. Our first patient presented to her primary gynaecologist with profuse vaginal bleeding and underwent total abdominal hysterectomy and bilateral salpingo-oophrectomy. She had fibroadenoma excised from her left breast four years previously. Histopathology revealed lobular carcinoma diffusely infiltrating uterus, cervix, and bilateral ovaries. Retrospective examination of the left breast showed induration along the previous fibroadenoma excision scar. A biopsy from the scar suggested lobular carcinoma. Our second patient presented with a hard indurated cervix mass that mimicked primary cervix carcinoma. She had ILC of the right breast four years previously for which she underwent mastectomy followed by adjuvant chemotherapy and radiotherapy. She was on tamoxifen. Further evaluation at presentation with imaging showed extensive intra-abdominal disease involving peritoneum with moderate ascites, adnexal masses, and confluent para-aortic nodal mass. A cervix biopsy confirmed metastasis from lobular carcinoma. Metastatic involvement of the genital tract should be considered in women with a history of breast cancer who present with abnormal vaginal bleeding, suspicious pelvic examination, or radiological findings. We suggest such patient be vigorously screened with biopsy even if the patient is disease-free for several years. It is crucial to differentiate the metastasis from primary carcinoma of the genital tract as there are vast differences in the management of each.
乳腺浸润性小叶癌（ILC）表现出不寻常的临床病理、放射学、组织学和转移模式。我们在此报告两例乳腺ILC，其转移模式异常，累及子宫。我们的首例患者因大量阴道出血就诊于她的初级妇科医生处，随后接受了全腹子宫切除术和双侧输卵管卵巢切除术。她四年前曾切除左乳纤维腺瘤。组织病理学显示小叶癌弥漫性浸润子宫、宫颈和双侧卵巢。对左乳进行回顾性检查发现，在先前纤维腺瘤切除瘢痕处有硬结。瘢痕活检提示为小叶癌。我们的第二例患者表现为坚硬的宫颈肿物，疑似原发性宫颈癌。她四年前曾患右乳ILC，为此接受了乳房切除术，随后进行辅助化疗和放疗。她正在服用他莫昔芬。就诊时进一步的影像学评估显示广泛的腹腔内病变，累及腹膜，伴有中度腹水、附件肿物和融合的主动脉旁淋巴结肿物。宫颈活检证实为小叶癌转移。有乳腺癌病史的女性出现异常阴道出血、盆腔检查可疑或有影像学异常时，应考虑生殖道转移。我们建议即使患者已无病数年，也应对此类患者进行积极的活检筛查。区分转移瘤与生殖道原发性癌至关重要，因为二者的治疗方法有很大差异。
