Vulvar Metastasis From Bilateral Lobular Breast Carcinoma

Abstract

INTRODUCTION: The invasive lobular carcinoma is the second most frequent pathological type of breast cancer, accounting for about 5-10% of breast carcinomas. Recent studies suggest an increase in incidence in relation to invasive ductal carcinoma, especially in women over age 50. The CLI has characteristic patterns of metastasis, showing the most commonly bilateral and metastases to peritoneum, gastrointestinal tract, gynecological organs, bone marrow and leptomeninges. The case reported below refers to a patient treated at the Hospital Aristides Maltez - BA, in 2002. REPORT: C. L. S. , 77 years old woman, sent to Mastology department by the Gynecology’s sector from the Hospital Aristides Maltez on 03/09/2010, whose main complaint was a lump in the vulva for 03 years. The patient had noted a small lump in the vulva for about 03 years, with faster growth in the last 06 months. Vulvar examination showed bulging of the right labia majora with almost complete erasure of the small ipsilateral lip. Hard and irregular mass of about 2.5 x2, 0cm in the right labium, which bulged the vaginal opening. We performed an incisional biopsy of that lesion which was consistent with invasive carcinoma with standard immunohistochemistry resembling ductal carcinoma of the breast. Under evaluation by mastologist there were no founds to inspection, there was a palpable dense area of about 02cm in upper outer quadrant (UOQ) right breast as well as in the union of the upper quadrants (UUQ) in the left breast, another nodule in the left breast measuring 01 cm fibroelastic consistency in UOQ. In the left axilla there was a lymph node measuring 01 cm with fibroelastic consistency. There was no nipple discharge. Mammography showed focal asymmetry in right breast union of lower quadrants (ULQ), Bi-Rads 0. Left breast presenting benign vascular calcifications, Bi-Rads 2. Ultrasound showed a heterogeneous hypoechoic poorly delimited area, measuring about 13. 3 x 6, 7mm, which may correspond to solid nodule in the right breast. The left breast showed a hypoechoic heterogeneous area in UUQ, measuring 10. 3 x7, 5mm. We performed core needle biopsy of palpable areas, the result was compatible with invasive lobular carcinoma in both breasts. The staging tests were normal, except for the chest x-ray showed diffuse interstitial infiltrate predominating in lung bases. The patient died before starting treatment due to respiratory complications. DISCUSSION: This case is relevant to show an unusual site for metastasis from infiltrating lobular carcinoma. It also shows the importance of inclusion of mammary carcinoma in the differential diagnosis of vulvar diseases.