Deng Ruoying, Meng Ze, Li Qiang, Wang Yarong, Lan Yuyun, Liu Yao, Liu Yibing
Department of Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Department of Digestive, The Second Affiliated Hospital of Xingtai Medical College, Xingtai, Hebei, China.
Front Oncol. 2025 Sep 8;15:1598840. doi: 10.3389/fonc.2025.1598840. eCollection 2025.
Occult breast cancer (OBC) is characterized as a breast carcinoma that remains undetectable through imaging modalities. OBC is a rare condition, accounting for only 0.3%-1.0% of all breast cancers, and is often clinically associated with metastases to the axillary and cervical lymph nodes. Metastasis of occult primary breast cancer to the cervix, stomach, or rectum is exceptionally rare. Here, we report the case of a 64-year-old woman presenting with clinical symptoms of urinary urgency, frequency, severe rectal discomfort, and altered stool morphology. Ga68-positron emission tomography-computed tomography (Ga68-FAPI PET/CT) identified diffuse tumor-associated fibrin expression within the gastric wall, while 18F-fluorodeoxyglucose PET/CT (18F-FDG PET/CT) revealed marked annular thickening of the rectal wall. Notably, imaging evaluations, including mammography, breast ultrasonography, and 18F-FDG PET/CT, failed to detect primary breast lesions. Histopathological examination and immunohistochemical analysis of biopsied cervical, gastric, and rectal lesions confirmed the diagnosis of OBC. Following six months of treatment with letrozole (1mg/day) in combination with dalpiciclib the patient demonstrated significant symptomatic relief, with remarkable reduction in the lesions located in the cervix, stomach, and rectum. This case represents the first documented instance of occult primary breast cancer with simultaneous metastases to the cervix, stomach, and rectum.
隐匿性乳腺癌（OBC）的特征是通过影像学检查无法检测到的乳腺癌。OBC是一种罕见疾病，仅占所有乳腺癌的0.3%-1.0%，在临床上常与腋窝和颈部淋巴结转移相关。隐匿性原发性乳腺癌转移至宫颈、胃或直肠极为罕见。在此，我们报告一例64岁女性病例，其出现尿急、尿频、严重直肠不适和大便形态改变等临床症状。镓68正电子发射断层扫描-计算机断层扫描（Ga68-FAPI PET/CT）显示胃壁内弥漫性肿瘤相关纤维蛋白表达，而18F-氟脱氧葡萄糖PET/CT（18F-FDG PET/CT）显示直肠壁明显环形增厚。值得注意的是，包括乳腺X线摄影、乳腺超声和18F-FDG PET/CT在内的影像学评估均未检测到原发性乳腺病变。对活检的宫颈、胃和直肠病变进行组织病理学检查和免疫组化分析，确诊为OBC。在接受来曲唑（1mg/天）联合达尔西利治疗六个月后，患者症状明显缓解，宫颈、胃和直肠的病变显著减少。该病例是首例记录在案的隐匿性原发性乳腺癌同时转移至宫颈、胃和直肠的病例。
