Breast cancer with cervix, lung and neck metastases: a case report and literature review.

Abstract

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 HER2 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 HER2 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 HER2 amplification. Later, cervical, pulmonary, and neck metastases were ER-negative, PR-negative, and HER2 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.