A rare case report of incidental solitary uterine metastasis in primary invasive lobular carcinoma of breast

Abstract

Introduction: Infiltrating Lobular carcinoma (ILC) of the breast is second most common cancer of breast next only to Infiltrating ductal carcinoma (IDC). It has a different metastatic pattern as compared to the IDC. Breast cancer is the most frequent primary site which spreads to gynaecologic organs. Case Presentation: A 40 yrs old Iraqi lady presented as a diagnosed case of lobular carcinoma of left breast. She had already undergone a lumpectomy at Iraq a month back and now had come for completion of treatment. On metastatic workup with PETCT scan, we found a multicentric residual disease in the left breast along with some ipsilateral axillary LN with significant uptake. The concurrent CECT done showed a uterine leiomyomam also. As she was strongly hormone receptor positive, had completed her family and was having mennorhagia probably attributable to uterine fibroids. She was offered hysterectomy with B/L salpingo-oophorectomy. She was keen for breast preservation but in view of her multicentricity of disease on the left breast she was counselled for mastectomy with upfront whole breast reconstruction with TRAM flap. She underwent left modified radical mastectomy with hysterectomy with BSO and TRAM flap reconstruction. The histopathological examination revealed a multicentric, multifocal ILC, grade II with heavy nodal involvement including extracapsular extension. The leiomyoma of uterus also showed tumor deposits from lobular carcinoma breast. Conclusion: We report a very rare case of metastatic pattern of carcinoma of breast. On literature review we found that it is common for the lobular carcinomas of breast to metastasise to gynaecologic organs. Uterine corpus is a very rare site of metastasis for extragenital cancers including breast. All the patients of primary lobular carcinoma of breast should be screened for gynaecologic secondaries in the preoperative workup with high degree of suspicion.