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Bouvier AS, Panchbhaya N, Brochard C, Marchand E, Mezzadri M, Leveau-Vallier AS, Cornelis F, Benifla JL, Mimoun C. Uterine metastasis from invasive ductal breast carcinoma: A case report with literature review. J Gynecol Obstet Hum Reprod 2020; 50:101993. [PMID: 33217599 DOI: 10.1016/j.jogoh.2020.101993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/14/2020] [Accepted: 11/15/2020] [Indexed: 10/23/2022]
Abstract
Breast cancer is the leading cause of cancer death in women, and most breast cancer related deaths are due to metastases. Uterine metastases from breast cancer are uncommon and rarely reported in the literature. We described the case of a 50 years-old-woman who developed a uterine metastasis, 6 years after the diagnosis of an invasive ductal breast carcinoma. Indeed, although the patient was asymptomatic, the monitoring imaging examinations, particularly the computed tomography (CT) and the positron emission tomography/computed tomography (PET/CT), showed a myometrial lesion. Non-conservative total hysterectomy was performed. The anatomo-pathological examination revealed a myometrial metastasis from an invasive ductal breast carcinoma. Seventeen months after surgery, the patient had no pelvic recurrence, but lungs and bones metastases progressed despite chemotherapy. In the lack of guidelines of uterine metastases from breast cancer's management, we reviewed the existing literature with the aim to provide a rational framework for clinical presentation, diagnostic approach, histological findings and treatment of this rare and heterogeneous pathology. Uterine metastases of breast cancer are frequently revealed with metrorrhagia. They occur preferentially in tumours with initial lobular carcinoma, initial lymph node involvement and positive hormonal receptors.
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Affiliation(s)
- Anne-Sophie Bouvier
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, Paris, France.
| | - Nabilah Panchbhaya
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, Paris, France
| | - Camille Brochard
- Department of Anatomopathology, Lariboisiere Hospital, Paris, France
| | - Eva Marchand
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, Paris, France
| | - Matthieu Mezzadri
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, Paris, France
| | | | | | - Jean-Louis Benifla
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, Paris, France
| | - Camille Mimoun
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, Paris, France
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Choi S, Joo JW, Do SI, Kim HS. Endometrium-Limited Metastasis of Extragenital Malignancies: A Challenge in the Diagnosis of Endometrial Curettage Specimens. Diagnostics (Basel) 2020; 10:diagnostics10030150. [PMID: 32164210 PMCID: PMC7151118 DOI: 10.3390/diagnostics10030150] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 02/29/2020] [Accepted: 03/05/2020] [Indexed: 02/03/2023] Open
Abstract
Malignancies of extragenital origin very rarely metastasize to the uterine body. Endometrium-limited metastases may pose diagnostic challenges in endometrial curettage specimens as they may be misdiagnosed as primary endometrial tumors. We investigated the clinicopathological characteristics of seven cases with endometrial-limited metastases from carcinomas of the nasopharynx (n = 1), breast (n = 2), colon (n = 2), stomach (n = 1), and appendix (n = 1). The patients' ages ranged from 36 to 71 (mean: 55.4) years. None of the patients had a remarkable gynecological history, and the presenting sign in all cases was abnormal uterine bleeding. Although myometrial involvement was absent, multiple metastases were already present in extrauterine locations such as the lung, liver, bone, abdominopelvic peritoneum, and omentum. All patients underwent ultrasonographic examination prior to endometrial curettage. The histologies of the endometrial metastases identified from the curettage specimens were identical to those of the corresponding primary tumors. Ancillary tests including immunostaining and Epstein-Barr virus-encoded RNA in situ hybridization confirmed the extragenital origin. Endometrium-limited metastases from extragenital malignancies are extremely rare. They present with abnormal vaginal bleeding and mimic endometrial carcinomas of endometrioid or poorly differentiated types. Since their clinical presentations and histological features are similar to those of primary endometrial tumors, pathologists should consider the possibility of metastases while evaluating endometrial curettage specimens obtained from patients with a history of extragenital malignancies.
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Affiliation(s)
- Sangjoon Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jin Woo Joo
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Sung-Im Do
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea;
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Correspondence: ; Tel.: +82-2-3410-1243
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Metastatic invasive lobular carcinoma of the breast to the endometrium presenting with abnormal uterine bleeding; Case report. Ann Med Surg (Lond) 2020; 51:41-43. [PMID: 32071717 PMCID: PMC7015833 DOI: 10.1016/j.amsu.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/06/2020] [Accepted: 01/25/2020] [Indexed: 11/24/2022] Open
Abstract
Metastatic cancer to the female genital organs is a very rare clinical presentation. The myometrium is more frequently affected than the endometrium. Prolonged use of tamoxifen has been found to be associated with endometrial hyperplasia, endometrial polyp formation, and the development of endometrial adenocarcinoma in some cases. A 55-year-old lady with a history of invasive lobular carcinoma of the breast that had been operated upon with left mastectomy 7 years previously & who had also been treated with tamoxifen for 5 years presented with irregular vaginal bleeding and lower abdominal pain. The patient had a three cm uterine fibroid with an endometrial polyp. She had anemia with hemoglobin level 8 mg/dl. Laparoscopic hysterectomy with bilateral oophorectomy was performed for a polyp in the endometrium which proved to be a metastasis from her lobular carcinoma of the breast. Patients with breast cancer who present with abnormal vaginal bleeding should alert the physicians about the possibility of metastatic breast cancer to the uterus regardless the use of the hormonal therapy such as tamoxifen. The pathologists also should be aware of this possibility and they should examine the polyps very carefully to detect any metastatic foci especially if the patient has been treated with tamoxifen.
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Akhtar A, Ratra A, Puckett Y, Sheikh AB, Ronaghan CA. Synchronous Uterine Metastases from Breast Cancer: Case Study and Literature Review. Cureus 2017; 9:e1840. [PMID: 29344435 PMCID: PMC5766353 DOI: 10.7759/cureus.1840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Breast cancer rarely metastasizes to the uterus. Here, we report two breast cancer patients with synchronous metastases to the uterus. Case 1 highlights a 46-year-old female with invasive ductal carcinoma who presented with a breast mass and was found to have uterine enlargement on positron emission tomography (PET) scan. Biopsy revealed a metastatic 4 mm focus of breast cancer in the background of endometrial hyperplasia. Case 2 reports a 62-year-old postmenopausal female diagnosed with lobular carcinoma of the breast following an abnormal screening mammogram. A routine pap smear necessitated further workup, revealing simultaneous endometrial and cervical metastasis. Both patients did not have any gynecologic symptoms and presented a diagnostic challenge.
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Affiliation(s)
- Aisha Akhtar
- Department of Surgery, Texas Tech University Health Sciences Center
| | - Atul Ratra
- Internal Medicine, Texas Tech University Health Sciences Center
| | - Yana Puckett
- Department of Surgery, Texas Tech University Health Sciences Center
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5
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Razia S, Nakayama K, Tsukao M, Nakamura K, Ishikawa M, Ishibashi T, Ishikawa N, Sanuki K, Yamashita H, Ono R, Hossain MM, Minamoto T, Kyo S. Metastasis of breast cancer to an endometrial polyp, the cervix and a leiomyoma: A case report and review of the literature. Oncol Lett 2017; 14:4585-4592. [PMID: 29085457 PMCID: PMC5649554 DOI: 10.3892/ol.2017.6822] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/13/2017] [Indexed: 11/26/2022] Open
Abstract
Haematogenous metastases of breast cancer tumors has previously been demonstrated to frequently occur at the sites of the lung, bones, liver and brain, however presence in the uterine remains a rare occurrence. Metastatic carcinoma of the uterus usually originates from other genital sites, most frequently from the ovaries. The current review presents the first reported case of lobular breast carcinoma metastasizing to an endometrial polyp, the cervix and a leiomyoma simultaneously. The patient (58 years, female) first presented with abnormal uterine bleeding. Invasive ductal carcinoma had previously been diagnosed in her right breast, with lobular and ductal cancer cells observed to be present in her lymph nodes. A hysteroscopic procedure to examine the postmenopausal bleeding revealed an endometrial polyp, which was subsequently resected. The morphology and immunohistochemical studies confirmed the diagnosis of metastasis of lobular breast carcinoma to an endometrial polyp. An 18F fludeoxyglucose positron emission tomography/computed tomography (PET-CT) scan performed following the diagnosis, revealed a slightly increased uptake in the myoma, which is often observed in benign uterine leiomyoma. The patient then underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and partial colectomy. Pathology results demonstrated that the uterine leiomyoma and cervix shared the same histopathological features as those presented by the primary lobular breast carcinoma. Although rare, breast tumors may metastasize to an endometrial polyp, cervix and leiomyoma concurrently in patients, therefore physicians may now consider the potential of the diagnosis of metastatic spread to the genital tract, in a patient with abnormal uterine bleeding and a history of lobular breast cancer. Gynecologists planning a laparoscopic hysterectomy for a patient with a history of lobular breast carcinoma may consider abdominal rather than laparoscopic hysterectomy, as lobular carcinoma is difficult to detect. The use of PET-CT may be beneficial for the identification of an unexpected mass.
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Affiliation(s)
- Sultana Razia
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Kentaro Nakayama
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Mayu Tsukao
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Kohei Nakamura
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Masako Ishikawa
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Tomoka Ishibashi
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Noriyoshi Ishikawa
- Department of Organ Pathology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Kaori Sanuki
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Hitomi Yamashita
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Ruriko Ono
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Mohammad Mahmud Hossain
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Toshiko Minamoto
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
| | - Satoru Kyo
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
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Di Tommaso L, Rahal D, Bresciani G, Roncalli M. Cutaneous Melanoma Metastatic to Uterine Adenomyoma: Report of a Case. Int J Surg Pathol 2016; 13:223-5. [PMID: 15864390 DOI: 10.1177/106689690501300217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rare cases of metastasis to uterine polyps have been reported in English literature but not, to the best of our knowledge, to uterine adenomyomas. All these cases are represented by breast cancer, most of them involving tamoxifen-associated polyps. We first report a case of cutaneous malignant melanoma metastatic to uterine adenomyoma. A computed tomography scan did not reveal any further evidence of disease, suggesting that this metastatic localization may represent something more than a fortuitous case. Based on these observations it is suggested that a subset of malignant melanoma and breast cancer cells share a sort of “homing” phenomenon to polypoid lesions of uterus, due probably to the presence of some chemokines and their specific receptors. Pathologists should be aware of this possibility in order to look carefully for metastatic implants in similar lesions. It is proposed that chemokine profile of neoplastic cells can be a useful tool in predicting metastatic targets.
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Affiliation(s)
- Luca Di Tommaso
- Department of Pathology, School of Medicine University of Milan, Humanitas Clinical Institute, Rozzano, Italy
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7
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Synchronous Metastasis From Lobular Carcinoma and Primary Carcinoma of the Endometrium in a Patient After Tamoxifen Therapy. Int J Gynecol Pathol 2013. [DOI: 10.1097/pgp.0b013e318257ded2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Bartosch C, Manuel Lopes J, Oliva E. Endometrial carcinomas: a review emphasizing overlapping and distinctive morphological and immunohistochemical features. Adv Anat Pathol 2011; 18:415-37. [PMID: 21993268 DOI: 10.1097/pap.0b013e318234ab18] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This review focuses on the most common diagnostic pitfalls and helpful morphologic and immunohistochemical markers in the differential diagnosis between the different subtypes of endometrial carcinomas, including: (1) endometrioid versus serous glandular carcinoma, (2) papillary endometrioid (not otherwise specified, villoglandular and nonvillous variants) versus serous carcinoma, (3) endometrioid carcinoma with spindle cells, hyalinization, and heterologous components versus malignant mixed müllerian tumor, (4) high-grade endometrioid versus serous carcinoma, (5) high-grade endometrioid carcinoma versus dedifferentiated or undifferentiated carcinoma, (6) endometrioid carcinoma with clear cells versus clear cell carcinoma, (7) clear cell versus serous carcinoma, (8) undifferentiated versus neuroendocrine carcinoma, (9) carcinoma of mixed cell types versus carcinoma with ambiguous features or variant morphology, (10) Lynch syndrome-related endometrial carcinomas, (11) high-grade or undifferentiated carcinoma versus nonepithelial uterine tumors. As carcinomas in the endometrium are not always primary, this review also discusses the differential diagnosis between endometrial carcinomas and other gynecological malignancies such as endocervical (glandular) and ovarian/peritoneal serous carcinoma, as well as with extra-gynecologic metastases (mainly breast and colon).
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Antic T, Gong Y, Sneige N. Tumor type and single-cell/mesothelial-like cell pattern of breast carcinoma metastases in pleural and peritoneal effusions. Diagn Cytopathol 2010; 40:311-5. [DOI: 10.1002/dc.21563] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 09/02/2010] [Indexed: 11/10/2022]
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11
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Metastasis of Adenocarcinoma of the Gall Bladder to an Endometrial Polyp Detected by Endometrial Curettage: Case Report and Review of the Literature. Int J Gynecol Pathol 2009; 28:343-6. [DOI: 10.1097/pgp.0b013e318192927d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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MANIPADAM MT, WALTER NM, SELVAMANI B. Lobular carcinoma metastasis to endometrial polyp unrelated to tamoxifen. APMIS 2008; 116:538-40. [DOI: 10.1111/j.1600-0463.2008.00940.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Abstract
Invasive lobular carcinoma (ILC) and lobular carcinoma in situ characteristically show loss of E-cadherin expression and so immunohistochemistry for E-cadherin is being increasingly used as a tool to differentiate between lobular and ductal lesions in challenging situations. However, misinterpretation of "aberrant" positive staining may lead some to exclude a diagnosis of lobular carcinoma. E-cadherin and beta-catenin immunohistochemistry was analyzed in 25 ILCs. E-cadherin "positive" ILCs were subjected to molecular analysis including comparative genomic hybridization. Different morphologic components of case 25, showing heterogenous E-cadherin expression, were analyzed by E-cadherin gene sequencing, methylation, and DASL gene expression profiling. Four ILCs were positive for E-cadherin, but each also had neoplastic cells with aberrant staining. Two of these ILCs were positive for beta-catenin, again with some aberrantly stained neoplastic cells, and 2 were negative. The solid component of case 25 was positive for E-cadherin whereas the classic and alveolar areas were negative. All components harbored an in-frame deletion in exon 7 (867del24) of the E-cadherin gene and loss of the wild type allele. Comparative genomic hybridization demonstrated evidence of clonal evolution from E-cadherin-positive to E-cadherin-negative components. E-cadherin down-regulation seems to be through transcriptional repression via activation of transforming growth factor-beta/SMAD2 rather than methylation. Positive staining for E-cadherin should not preclude a diagnosis of lobular in favor of ductal carcinoma. Molecular evidence suggests that even when E-cadherin is expressed, the cadherin-catenin complex maybe nonfunctional. Misclassification of tumors may lead to mismanagement of patients in clinical practice, particularly in the context of in situ disease at margins.
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14
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Salman T, Massiah N, Burns S, Mills S. Metastatic breast cancer to the cervix and myometrium. J OBSTET GYNAECOL 2007; 27:753-4. [PMID: 17999323 DOI: 10.1080/01443610701631060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- T Salman
- Department of Obstetrics and Gynaecology, Royal Albert Edward Infirmary, Wigan, UK.
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Abstract
A major proportion of the workload in many histopathology laboratories is accounted for by endometrial biopsies, either curettage specimens or outpatient biopsy specimens. The increasing use of pipelle and other methods of biopsy not necessitating general anaesthesia has resulted in greater numbers of specimens with scant tissue, resulting in problems in assessing adequacy and in interpreting artefactual changes, some of which appear more common with outpatient biopsies. In this review, the criteria for adequacy and common artefacts in endometrial biopsies, as well as the interpretation of endometrial biopsies in general, are discussed, concentrating on areas that cause problems for pathologists. An adequate clinical history, including knowledge of the age, menstrual history and menopausal status, and information on the use of exogenous hormones and tamoxifen, is necessary for the pathologist to critically evaluate endometrial biopsies. Topics such as endometritis, endometrial polyps, changes that are induced by hormones and tamoxifen within the endometrium, endometrial metaplasias and hyperplasias, atypical polypoid adenomyoma, adenofibroma, adenosarcoma, histological types of endometrial carcinoma and grading of endometrial carcinomas are discussed with regard to endometrial biopsy specimens rather than hysterectomy specimens. The value of ancillary techniques, especially immunohistochemistry, is discussed where appropriate.
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Affiliation(s)
- W G McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast, Northern Ireland.
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Altaner S, Gucer F, Tokatli F, Guresci S, Ozdemir C, Puyan FO, Kutlu K. Expression of Bcl-2 and Ki-67 in Tamoxifen-Associated Endometrial Polyps: Comparison with Postmenopausal Polyps. Oncol Res Treat 2006; 29:376-80. [PMID: 16974115 DOI: 10.1159/000094443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the expression of Bcl-2 and Ki-67 in tamoxifen (TAM)-associated endometrial polyps and postmenopausal polyps. MATERIAL AND METHODS For this purpose, a retrospective analysis of paraffin-embedded specimens was carried out. Polyps of 20 postmenopausal and 14 TAM-treated patients, 11 simple endometrial hyperplasia, 10 atypical complex endometrial hyperplasia and 8 endometrial adenocarcinoma specimens were included in the study. Hematoxylin/eosin-stained sections were evaluated. Immunohistochemical staining was performed to investigate the expression of Bcl-2 protein and the Ki-67 proliferation index. RESULTS There was no statistically significant difference between the 5 groups with regard to Bcl- 2 staining (p > 0.05). However, Bcl-2 expression in TAM-associated polyps was higher (86%) than in the postmenopausal control group (80%). Positive Ki-67 was highest in the endometrial adenocarcinoma specimens, followed by the atypical complex endometrial hyperplasia group (p < 0.0001). Compared to these 2 groups, Ki- 67 expression was lower in TAM-associated polyps, but Ki-67 indexes were significantly higher in the TAM-associated group than in the control group (p < 0.0001). CONCLUSION Since TAM-associated polyps tend to have higher proliferation indexes and Ki-67 ratios than control groups, we suggest that they are likely to have a higher malignant potential.
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Affiliation(s)
- Semsi Altaner
- Department of Pathology, Faculty of Medicine, Trakya University, Edirne, Turkey.
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Erkanli S, Kayaselcuk F, Kuscu E, Bolat F, Sakalli H, Haberal A. Lobular carcinoma of the breast metastatic to the uterus in a patient under adjuvant anastrozole therapy. Breast 2006; 15:558-61. [PMID: 16311034 DOI: 10.1016/j.breast.2005.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Revised: 10/13/2005] [Accepted: 10/18/2005] [Indexed: 10/25/2022] Open
Abstract
This is the first report of breast carcinoma metastatic to the endometrium in a patient on adjuvant anastrozole therapy. We report a case of metastatic lobular carcinoma of the breast in a 63-year-old patient on adjuvant anastrozole therapy for 8 months. She was asymptomatic and metastatic endometrium was diagnosed after transvaginal ultrasound revealed suspicious findings along with elevated Ca 15-3 levels. As further work up showed no other metastatic sites her uterus was taken out along with her ovaries and pelvic lymph nodes. Uterine metastases should be kept in mind in asymptomatic patients on anastrozole therapy.
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MESH Headings
- Anastrozole
- Antineoplastic Agents, Hormonal/therapeutic use
- Aromatase Inhibitors/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/pathology
- Chemotherapy, Adjuvant
- Endometrial Neoplasms/secondary
- Endometrial Neoplasms/surgery
- Female
- Humans
- Hysterectomy
- Immunohistochemistry
- Keratins/metabolism
- Mastectomy, Modified Radical
- Middle Aged
- Mucin-1/blood
- Nitriles/therapeutic use
- Ovariectomy
- Triazoles/therapeutic use
- Ultrasonography
- Vagina/diagnostic imaging
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Affiliation(s)
- Serkan Erkanli
- Department of Obstetrics & Gynecology, Baskent University School of Medicine, Seyhan- Adana, Turkey.
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Mbatsogo BA, Le Bouëdec G, Michy T, Bourdel N, Fouilloux G, Dauplat J. Dégénérescence maligne de polypes endométriaux sous tamoxifène. ACTA ACUST UNITED AC 2005; 33:975-9. [PMID: 16321556 DOI: 10.1016/j.gyobfe.2005.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 10/18/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To review and describe the anatomoclinical cases of the endometrial cancers arising on polyps during a hormonotherapy by tamoxifen for breast cancer. PATIENTS AND METHODS In the surgical inventory 1990-2002 of the benign or malignant uterine lesions investigated by hysteroscopy with dilatation & curettage (D&C) and/or hysterectomy, 108 single or multiple endometrial polyps were encountered and histologically analyzed. RESULTS A malignant transformation of polyp was found in 5 instances, meaning a rate of 4.6% i.e. 5/108: 4 cases of adenocarcinoma, 1 case of sarcoma. DISCUSSION AND CONCLUSION The existence of endometrial polyps - symptomatic or not - does not seem compatible with the prolonged use of tamoxifen treatment owing the estrogen agonist potential effects of tamoxifen and its well-known hyperplastic and carcinogenic properties for the endometrium. The increased risk of endometrial cancer developing in polyps in this iatrogenic context is estimated between 2.5% and 10% in the literature.
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Affiliation(s)
- B Anama Mbatsogo
- Service de chirurgie, centre de lutte contre le cancer (CLCC) Jean-Perrin, Clermont-Ferrand, France
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Al-Brahim N, Elavathil LJ. Metastatic breast lobular carcinoma to tamoxifen-associated endometrial polyp: case report and literature review. Ann Diagn Pathol 2005; 9:166-8. [PMID: 15944961 DOI: 10.1016/j.anndiagpath.2005.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Tamoxifen is a widely used adjuvant treatment of breast carcinoma with partial estrogenic agonist effect. This activity may result in a spectrum of proliferative endometrial abnormalities including uterine polyps. We report a 53-year-old woman receiving tamoxifen for previously excised breast lobular carcinoma who presented with vaginal bleeding. Histologic examination of the endometrium revealed typical morphology of tamoxifen-associated polyp with foci of metastatic lobular carcinoma. Metastatic breast carcinoma to tamoxifen-associated polyp has rarely been described in the literature. Pathologists and gynecologists should be aware of this possibility in women who have a history of breast carcinoma and who are receiving tamoxifen. Careful histologic evaluation of the endometrium is crucial.
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Affiliation(s)
- Nabeel Al-Brahim
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
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Acikalin MF, Oner U, Tekin B, Yavuz E, Cengiz O. Metastasis from breast carcinoma to a tamoxifen-related endometrial polyp. Gynecol Oncol 2005; 97:946-8. [PMID: 15896832 DOI: 10.1016/j.ygyno.2005.03.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Revised: 02/04/2005] [Accepted: 03/13/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Metastasis of extragenital neoplasms to an endometrial polyp is rare and until now, only 6 cases of such involvement has been described. CASE A 58-year-old woman, who had been diagnosed 4 years ago with infiltrating ductal breast carcinoma and treated with surgery and tamoxifen therapy, was admitted to the gynecology clinic because of endometrial thickening observed during a routine abdominal ultrasonographic examination. A total hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological examination of the specimen showed a large polyp which microscopically showed clusters of cells with signet ring morphology within the polyp stroma. The positivity of tumor cells for GCDFP-15 supported the diagnosis of metastatic breast carcinoma to endometrial polyp. CONCLUSION Metastatic breast carcinoma should be considered in the differential diagnosis of carcinomas with signet ring cell morphology involving uterus.
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Scopa CD, Aletra C, Lifschitz-Mercer B, Czernobilsky B. Metastases of breast carcinoma to the uterus. Report of two cases, one harboring a primary endometrioid carcinoma, with review of the literature. Gynecol Oncol 2005; 96:543-7. [PMID: 15661249 DOI: 10.1016/j.ygyno.2004.09.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND Metastases to the uterus are rare, accounting for less than 10% of all cases of metastases to the female genital tract from extragenital cancers. The endometrium is even less frequently affected by metastases. Lobular carcinoma is the most common type of breast cancer that metastasizes to the uterus. CASES Two cases of infiltrating lobular carcinoma of the breast metastatic to endometrium and myometrium, one of them harboring an endometrioid adenocarcinoma, are reported. Both patients were on tamoxifen therapy and presented with uterine bleeding. CONCLUSION To the best of our knowledge, uterine carcinoma serving as recipient of metastatic carcinoma from the breast has not been previously documented. This possibility should be considered when an unusual bimorphic pattern appears in a tumor until proven otherwise.
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Affiliation(s)
- Chrisoula D Scopa
- Department of Pathology, Regional University Hospital, University of Patras, Medical School, Patras, Greece.
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