Published online Jan 16, 2024. doi: 10.12998/wjcc.v12.i2.412
Peer-review started: October 9, 2023
First decision: November 13, 2023
Revised: November 27, 2023
Accepted: December 22, 2023
Article in press: December 22, 2023
Published online: January 16, 2024
Cervical cancer is a rare primary tumor resulting in metastases to the breast with few cases reported in literature. Breast metastases are associated with poor prognosis. The following case highlights the diagnostic challenges associated with metastatic cervical cancer to the breast along with individualized treatment.
A 44-year-old G7P5025 with no significant past medical or surgical history presented with heavy vaginal to an outside emergency department where an exam and a pelvic magnetic resonance imaging showed a 4.5 cm heterogenous lobulated cervical mass involving upper two thirds of vagina, parametria and lymph node metastases. Cervical biopsies confirmed high grade adenocarcinoma with mucinous features. A positron emission tomography/computed tomography (PET/CT) did not show evidence of metastatic disease. She received concurrent cisplatin with external beam radiation therapy. Follow up PET/CT scan three months later showed no suspicious fluorodeoxyglucose uptake in the cervix and no evidence of metastatic disease. Patient was lost to follow up for six months. She was re-imaged on re-presentation and found to have widely metastatic disease including breast disease. Breast biopsy confirmed programmed death-ligand 1 positive metastatic cervical cancer. The patient received six cycles of carboplatin and paclitaxel with pembrolizumab. Restaging imaging demonstrated response. Patient continued on pembrolizumab with disease control.
Metastatic cervical cancer to the breast is uncommon with nonspecific clinical findings that can make diagnosis challenging. Clinical history and immunohistochemical evaluation of breast lesion, and comparison to primary tumor can support diagnosis of metastatic cervical cancer to the breast. Overall, the prognosis is poor, but immunotherapy can be considered in select patients and may result in good disease response.
Core Tip: Metastatic cervical cancer to the breast is rare with nonspecific clinical findings that can make diagnosis challenging. Clinical history, histology and immunohistochemical evaluation of the breast lesion, and comparison to the primary tumor can support the diagnosis of metastatic cervical cancer rather than a primary breast malignancy. Overall, the prognosis is poor, but immunotherapy can be considered in select patients and may result in good disease response.