Wang Xiaomei, Wei Shumei
Department of Pathology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China.
AME Case Rep. 2024 Sep 2;8:102. doi: 10.21037/acr-24-36. eCollection 2024.
Breast cancer has the potential to metastasize to various sites; however, cases of metastasis to the cervix are rare. Here, we present clinical and pathological data from a rare case of primary breast cancer metastasis to the cervix, including imaging characteristics and clinical progression.
A 68-year-old female patient self-detected nodules in her right breast. B-ultrasound examination revealed multiple nodules in the right breast, classified as Breast Imaging Reporting and Data System (BI-RADS) 4c. Radical treatment for right breast cancer was commenced. Histopathologic diagnosis revealed invasive ductal breast carcinoma of no specific type, with intraductal carcinoma in the right breast. Immunohistochemical analysis indicated that the tumor was androgen receptor (AR)-diffuse strong positive, estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, with human epidermal receptor-2 (HER2, c-erbB-2) overexpression, and Ki-67 proliferation index 60%. The tumor was positive for GATA binding protein 3 (GATA-3) and fluorescence in situ hybridization (FISH) analysis revealed gene amplification. Chemotherapy was discontinued after completing three cycles. Three years after stopping chemotherapy, she experienced lower abdominal, pain with cervical bleeding, and underwent aspiration biopsy. Immunohistochemical results indicated: AR-diffuse strong positive, ER-negative, PR-negative, c-erbB-2-negative, and Ki-67 30%, with gross cystic disease fluid protein-15 (GCDFP-15) and GATA-3 both diffuse strong positive. Lung mass detection prompted lung puncture and biopsy, with immunohistochemical results: ER-negative, PR-negative, c-erbB-2-positive, Ki-67 30%, with GCDFP-15-diffuse positive, and GATA-3-diffuse positive. No gene amplification was detected by FISH. She was diagnosed with ductal breast carcinoma metastasized to the uterus and lung, based on morphological, immunohistochemical, and clinical findings. Eight months later, she developed a neck mass, and mass puncture and biopsy confirmed metastatic breast cancer [immunohistochemical results: ER-negative, PR-negative, c-erbB-2-positive, Ki-67 30%, trichorhinophalangeal syndrome type 1 (TRPS1)-positive, and GATA-3-positive]. The primary tumor was ER-negative, PR-negative, with amplification. Later, cervical, pulmonary, and neck metastases were ER-negative, PR-negative, and negative. The patient remains alive; last follow-up was February 15, 2024, 50 months after radical treatment for breast cancer.
We report a relatively rare case of primary breast cancer metastasis to three metastatic sites: cervix, lung, and neck. To our best knowledge, this is the first report of primary breast cancer metastasis to three sites including the cervix.
乳腺癌有转移至不同部位的可能；然而，转移至宫颈的病例较为罕见。在此，我们呈现一例原发性乳腺癌转移至宫颈的罕见病例的临床及病理数据，包括影像学特征和临床病程。
一名68岁女性患者自行发现右乳有结节。B超检查显示右乳有多个结节，分类为乳腺影像报告和数据系统（BI-RADS）4c级。遂开始对右乳癌进行根治性治疗。组织病理学诊断显示为非特殊类型的浸润性导管癌，右乳存在导管内癌。免疫组化分析表明，肿瘤雄激素受体（AR）弥漫强阳性，雌激素受体（ER）阴性，孕激素受体（PR）阴性，人表皮生长因子受体2（HER2，c-erbB-2）过表达，Ki-67增殖指数为60%。肿瘤GATA结合蛋白3（GATA-3）阳性，荧光原位杂交（FISH）分析显示基因扩增。完成三个周期化疗后停止化疗。停止化疗三年后，她出现下腹部疼痛伴宫颈出血，并接受了穿刺活检。免疫组化结果显示：AR弥漫强阳性，ER阴性，PR阴性，c-erbB-2阴性，Ki-67为30%，大汗腺囊肿病液蛋白-15（GCDFP-15）和GATA-3均弥漫强阳性。肺部肿块检查提示进行肺穿刺活检，免疫组化结果为：ER阴性，PR阴性，c-erbB-2阳性，Ki-67为30%，GCDFP-15弥漫阳性，GATA-3弥漫阳性。FISH检测未发现基因扩增。根据形态学、免疫组化及临床检查结果，她被诊断为导管乳腺癌转移至子宫和肺。八个月后，她出现颈部肿块，肿块穿刺活检确诊为转移性乳腺癌[免疫组化结果：ER阴性，PR阴性，c-erbB-2阳性，Ki-67为30%，1型毛发鼻指综合征（TRPS1）阳性，GATA-3阳性]。原发肿瘤ER阴性，PR阴性，存在 扩增。后来，宫颈、肺部及颈部转移灶均ER阴性，PR阴性， 阴性。患者仍然存活；最后一次随访时间为2024年2月15日，即乳腺癌根治术后50个月。
我们报告了一例相对罕见的原发性乳腺癌转移至三个部位的病例：宫颈、肺和颈部。据我们所知，这是首例原发性乳腺癌转移至包括宫颈在内的三个部位的报告。
