Awazu Yuichiro, Fukuda Takeshi, Imai Kenji, Yamauchi Makoto, Kasai Mari, Ichimura Tomoyuki, Yasui Tomoyo, Sumi Toshiyuki
Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan.
Mol Clin Oncol. 2021 Dec;15(6):266. doi: 10.3892/mco.2021.2428. Epub 2021 Oct 28.
Uterine metastases from breast cancer are uncommon and have rarely been reported in the previous literature. The present report describes the case of a 66-year-old female who developed uterine metastasis 23 years following the primary treatment of invasive breast cancer. Specifically, the patient experienced multiple bone metastases 14 years following primary treatment and had previously been treated with aromatase inhibitors followed by tamoxifen citrate. The patient presented with abnormal genital bleeding and was referred to the Gynecology Department of the Osaka City University Hospital (Osaka, Japan) 23 years following the primary treatment. The results of an endometrial biopsy revealed adenocarcinoma. Initially, it was difficult to differentiate between primary endometrial adenocarcinoma and metastatic adenocarcinoma from breast cancer. The results of pelvic magnetic resonance imaging demonstrated uterine myometrium enlargement and no endometrial thickness. Furthermore, an abdominal total hysterectomy, bilateral salpingo-oophorectomy and a biopsy of the peritoneum were performed. The pathological examination of the resected uterus revealed adenocarcinoma, which proliferated diffusively in the cervical stroma, myometrium, cardinal ligament, bilateral adnexa, omentum and peritoneum. Immunohistochemical results revealed the positive staining of gross cystic disease fluid protein-15, as well as negative staining for CD10 and E-cadherin. Thus, the tumor was diagnosed as metastatic adenocarcinoma from the breast lobular carcinoma. The patient has since been treated with fulvestrant, toremifene citrate and tegafur, and the current patient survival duration is 2 years and 8 months. In conclusion, when patients with breast cancer undergoing hormonal therapy, such as tamoxifen, present with abnormal genital bleeding, future diagnoses should consider both endometrial cancer and uterine metastasis from breast cancer.
乳腺癌的子宫转移并不常见，以往文献中鲜有报道。本报告描述了一例66岁女性患者，在浸润性乳腺癌初次治疗23年后发生子宫转移。具体而言，该患者在初次治疗14年后出现多处骨转移，此前曾接受芳香化酶抑制剂治疗，随后使用枸橼酸他莫昔芬。患者出现生殖器异常出血，在初次治疗23年后转诊至日本大阪市立大学医院妇科。子宫内膜活检结果显示为腺癌。最初，很难区分原发性子宫内膜腺癌和乳腺癌转移性腺癌。盆腔磁共振成像结果显示子宫肌层增大，子宫内膜无增厚。此外，进行了腹式全子宫切除术、双侧输卵管卵巢切除术和腹膜活检。切除子宫的病理检查显示为腺癌，在宫颈间质、肌层、主韧带、双侧附件、大网膜和腹膜中弥漫性增殖。免疫组化结果显示巨囊性病液蛋白-15呈阳性染色，而CD10和E-钙黏蛋白呈阴性染色。因此，该肿瘤被诊断为乳腺小叶癌转移性腺癌。此后，该患者接受了氟维司群、枸橼酸托瑞米芬和替加氟治疗，目前患者的生存时间为2年8个月。总之，接受他莫昔芬等激素治疗的乳腺癌患者出现生殖器异常出血时，未来诊断应考虑子宫内膜癌和乳腺癌的子宫转移。
