Breast cancer with synchronous massive metastasis in uterine myoma: A case report and literature review | Clínica e Investigación en Ginecología y Obstetricia

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Transvaginal ultrasound described a hypoechoic subserosal-intramural mass (FIGO leiomyoma subclassification system: O-4) localized in the posterior uterine wall, measuring 23mm×19mm×13mm, slightly vascularized at the Color-Doppler (Color Score 2)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Derme, M. Briante, G. Masselli" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Derme" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Briante" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Masselli" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210573X24000200?idApp=UINPBA00004N" "url" => "/0210573X/0000005100000003/v2_202407010642/S0210573X24000200/v2_202407010642/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0210573X24000285" "issn" => "0210573X" "doi" => "10.1016/j.gine.2024.100965" "estado" => "S300" "fechaPublicacion" => "2024-07-01" "aid" => "100965" "copyright" => "Elsevier España, S.L.U." 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Kariman" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Banaei" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alidost" ] 2 => array:2 [ "nombre" => "H." "apellidos" => "Shahrahmani" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Yazdani" ] 4 => array:2 [ "nombre" => "Z." "apellidos" => "Sepehri" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "Kariman" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210573X24000285?idApp=UINPBA00004N" "url" => "/0210573X/0000005100000003/v2_202407010642/S0210573X24000285/v2_202407010642/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Case report" "titulo" => "Breast cancer with synchronous massive metastasis in uterine myoma: A case report and literature review" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Eroglu, S. Celik, F. Tatlidil, C. Caliskan, S.M. Aydin" "autores" => array:5 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Eroglu" "email" => array:1 [ 0 => "drsemraeroglu@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Celik" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Tatlidil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Caliskan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "S.M." "apellidos" => "Aydin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Samsun University, Department of Gynecology and Obstetrics, Samsun, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Samsun University, Educational and Research Hospital, Pathology Clinic, Samsun, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cáncer de mama con metástasis masiva sincrónica en mioma uterino: reporte de un caso y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 514 "Ancho" => 1007 "Tamanyo" => 32287 ] ] "descripcion" => array:1 [ "en" => "PET/CT examination no parenchymal lesion with pathological F-18 FDG uptake was detected in both breasts. Few lymph nodes, the largest of which is approximately 2cm in diameter on the right, with selected fatty hiluses, thought to be reactive." ] ] ] "textoCompleto" => "IntroductionBreast cancer ranks first in cancer-related deaths in women.<a class="elsevierStyleCrossRef" href="#bib0095">1</a> In recent years, early diagnosis and the appropriate treatment have increased the chance of survival. While ductal breast cancer accounts for 75% of all breast cancers, invasive lobular type is responsible for 80% of metastases to the genital organs.<a class="elsevierStyleCrossRefs" href="#bib0100">2,3</a> The most common extragenital metastases to the gynecologic organs are found in the breast, stomach and rectum.<a class="elsevierStyleCrossRef" href="#bib0110">4</a> Extragenital neoplasms frequently metastasize to the ovary and vagina, with concomitant uterine metastases being very rare, detected in only 10% of cases. Here, we report a case of breast cancer with synchronous massive metastasis in a uterine myoma, discussing and reviewing the clinical diagnosis, treatment course, and pathological characteristics.Information of patientA 42-year-old infertile female patient presented to the Gynecology Clinic of Tertiary Hospital with heavy menstrual bleeding. Ultrasonography revealed a 5cm uterine fibroid originating from the fundus. Due to anemia and menometrorrhagia, myomectomy was decided upon. Preoperative smear and endometrial biopsy results were benign.Clinical findingsIn the review of myomectomy preparations, infiltrates resembling solid layers and cell cords within the leiomyoma metastatic tumor were observed. Immunohistochemical analysis revealed positivity for pancytokeratin, GCDFP-15, cytokeratin 7, GATA 3, estrogen receptor (80%), and progesterone receptor (50%). TFF-1 showed focal positivity. c-erbB2 (Score: 0), SMA, Napsin A, Inhibin, SALL4, Pax8, cytokeratin 20, p63, CDX2, CD10, synaptophysin, chromogranin, CD56 were negative. E-cadherin staining exhibited loss. The Ki67 index was approximately 5%. These immunohistochemical findings were consistent with breast-derived lobular carcinoma metastasis (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 1</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>TimelineThe patient had no significant personal or family medical history. Obstetric-gynecological history revealed that the patient was in the reproductive period, nulliparous, and desiring pregnancy.Diagnostic evaluationThe patient underwent postoperative evaluation by general surgery and medical oncology. Breast ultrasound revealed multiple simple cysts in the left breast at 3 o’clock, measuring 10mm in diameter, and in the right breast at 9 o’clock, measuring 9mm in diameter. Additionally, a dense cystic lesion, 4mm in diameter, was observed near the nipple at the 10 o’clock position on the right breast. No circumscribed solid mass lesions were detected in either breast.In the right axilla, lymphadenopathies measuring of 21×13 and 18×9mm in size, with thick cortex and cortical-medullary differentiation were noted. However, no pathologically enlarged lymph nodes or masses were in the left axillary area. Positron emission tomography/computed tomography (PET/CT) examination revealed no parenchymal lesions with pathological F-18 FDG uptake in either breast. A few lymph nodes, the largest approximately 2cm in diameter on the right, exhibiting selected fatty hiluses and considered reactive, showed F-18 FDG uptake slightly above the background activity. No pathological findings were detected in the lung and mediastinum, and bone scintigraphy showed no involvement.Following the detection of breast cancer metastasis cells, the patient's PET/CT images were further evaluated (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Therapeutic interventionsThe patient underwent chemotherapy treatment with cyclophosphamide (600mg/m2 on Days 1–14)+and doxorubicin (60mg/m2 on Days 1–14) for two cycles, followed by paclitaxel (175mg/m2 on Weeks 1 and 3).Monitoring and resultsAt the 6-month follow-up, the patient remained well with no signs of disease progression.DiscussionBreast cancer stands as the most prevalent cause of cancer-related death in women.<a class="elsevierStyleCrossRef" href="#bib0095">1</a> The primary sites of metastases of in breast cancer are commonly the lung, bone, liver, brain and soft tissue. However, uterine metastasis represents a rare occurrence. The hallmark symptom of uterine metastasis is abnormal vaginal bleeding, typically observed in patients with endometrial metastases. Conversely, patients with exclusive myometrial metastases tend to remain asymptomatic. The metastatic process is attributed to the loss of E-cadherin protein expression in the tumor cell membrane, resulting in dysfunction of the E-cadherin–catenin complex, critical for intercellular adhesion.<a class="elsevierStyleCrossRef" href="#bib0115">5</a>Ductal carcinoma constitutes 70–75% of invasive breast cancer cases, with lobular carcinoma comprising 5–20%.<a class="elsevierStyleCrossRefs" href="#bib0110">4,6</a> In the study of Kondo et al., ductal carcinoma was identified as the primary type in 9 out of 11 cases of metastatic breast cancer.<a class="elsevierStyleCrossRef" href="#bib0130">8</a> However, metastatic spread of invasive lobular cancer (ILC) to bone is more frequent compared to invasive ductal carcinoma (IDC) and other metastatic organs.<a class="elsevierStyleCrossRef" href="#bib0125">7</a> Metastasis to the female genital tract from extragenital tumors is uncommon, primarily observed in cases of ILC if it occurs frequently.<a class="elsevierStyleCrossRefs" href="#bib0110">4,9</a> Mazur et al. examined 325 cases of female genital tract metastases, most frequently originating from colorectal (37.6%) and breast (34.9%) primaries, followed by stomach (5.4%) and appendix (2.7%).<a class="elsevierStyleCrossRef" href="#bib0110">4</a> The ovary is the most commonly affected organ in genital metastases, followed by the vagina, with only a small percentage metastasizing to the uterus.<a class="elsevierStyleCrossRefs" href="#bib0110">4,5,10</a> Uterine metastasis is indicative of a poor prognosis. The ovary is more susceptible to metastasis due to its rich vascular and lymphatic network, while the uterus metastasizes rarely due to widespread fibrous tissue and tight connections. Uterine metastases are believed to primarily occur via retrograde lymphatic spread from ovarian metastases. In cases of uterine metastasis, the myometrium is typically more affected than the endometrium, and metastasis to the myometrium is often asymptomatic.<a class="elsevierStyleCrossRef" href="#bib0145">11</a> Metastases were observed in 63.5% of myometrial cases, 32.7% in both myometrium and endometrium, and 3.8% solely in the endometrium. Uterine abnormal bleeding typically accompanies endometrial implantation.<a class="elsevierStyleCrossRef" href="#bib0140">10</a>In the literature, uterine metastasis of breast cancer has been limited to case reports. Due to the prevalence of uterine fibrous tissues and tight connections, metastasis to the uterus is rare.<a class="elsevierStyleCrossRef" href="#bib0110">4</a> Most reported cases involve patients previously diagnosed with breast cancer and undergoing tamoxifen treatment. These patients typically exhibit hormone receptor positivity and develop uterine metastasis due to increased chemokine activity, often diagnosed during routine gynecological examinations. In our case, benign breast examination findings were noted, but lobular breast cancer metastasis cells were detected in the pathology preparations of a patient who underwent myomectomy for gynecological complaints. To our knowledge, this represents the first reported case of synchronous lobular breast cancer and uterine leiomyoma metastasis.Similar to our case, Dirican et al. published a case involving uterine metastasis after breast cancer. They reported a 47-year-old woman with invasive ductal carcinoma, progesterone receptor positive (30%+), and c-erbB2 negative. The patient underwent partial mastectomy and axillary lymph node dissection. During gynecological examination, uterine cervix smear and probe curettage pathology were normal. Total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) were performed upon detection of a solid 8.5mm area in the uterus on abdominal CT. Metastasis of breast cancer was detected in the TAH and BSO specimens due to isolated CA 15-3 elevation. Post-surgery, a decrease in CA 15-3 levels was observed.<a class="elsevierStyleCrossRef" href="#bib0155">13</a>Isci et al. reported a case involving a 48-year-old patient with invasive lobular cancer in the left breast, diagnosed as estrogen receptor positive (ER+) and P-HER2 negative, with multiple bone and liver metastases at diagnosis. The patient was deemed inoperable and received chemotherapy. Initially, a 10cm leiomyoma was detected. Subsequently, upon presenting with abdominal tension and urinary incontinence 15 months later while on letrozole and ibandronate treatment, a giant myoma extending to the xiphoid line was found. TAH and BSO revealed metastases of breast cancer in both ovaries, fallopian tubes, abdominal washing fluid, myometrium, and the fibroid breast cancer. No metastasis was detected in the endometrium. The patient underwent cytotoxic therapy and was reported alive in the first postoperative year.<a class="elsevierStyleCrossRef" href="#bib0160">14</a>Tamoxifen, used in patients with ER+ breast cancer, has been associated with uterine leiomyoma enlargement and new myoma formation. Studies indicate an increased risk of uterine sarcoma.<a class="elsevierStyleCrossRef" href="#bib0165">15</a> Conversely, the aromatase inhibitor letrozole inhibits estrogen in breast and adipose tissue and is as effective as tamoxifen in ER+ breast cancer in postmenopausal women, without increasing the risk of endometrial cancer. In the reported case, contrary to the expected reduction in myoma with aromatase inhibitors, myoma growth was considered a sign of metastasis, prompting surgical intervention.<a class="elsevierStyleCrossRef" href="#bib0160">14</a>The ovary is the genital organ most frequently affected by metastasis, with the vagina ranking second. Bilici et al. documented a case of a postmenopausal woman with invasive ductal carcinoma who, after undergoing mastectomy and lymph node dissection followed by chemotherapy and anastrozole treatment, presented with abdominal pain six years post-diagnosis. An MRI of the abdomen identified an 8cm×7cm×6cm nodular mass in the uterus, suggestive of myoma uteri. Following total TAH and BSO, pathology confirmed the diagnosis as ovarian metastasis of invasive ductal carcinoma.<a class="elsevierStyleCrossRef" href="#bib0170">16</a> Berger et al. reported a case involving metastasis to both ovaries, tubes, the full thickness of the uterus, and the cervix,<a class="elsevierStyleCrossRef" href="#bib0175">17</a> while Kong et al. described metastases to the uterus and cervix following lobular breast cancer.<a class="elsevierStyleCrossRef" href="#bib0105">3</a> Additionally, Bogliolo et al. presented a 78-year-old patient with an enlarged uterus and cervix identified during routine gynecological examination, marking the first reported case of synchronous lobular breast cancer with cervical metastasis.<a class="elsevierStyleCrossRef" href="#bib0150">12</a>Given the rarity of uterine metastasis, the literature contains only a limited number of cases. Uterine metastases from breast cancer are uncommon and typically occur in patients at advanced stages of the disease, often involving the entire layer of the uterus. Research indicates that localized treatment of solitary metastases, whether through surgery alone or in combination with radiotherapy, can extend survival in patients with metastatic breast cancer.<a class="elsevierStyleCrossRef" href="#bib0180">18</a>Differentiating between primary and metastatic uterine cancer is crucial due to differences in treatment approaches. Biopsy and immunohistochemical staining are essential for suspicious lesions identified through imaging. Early detection and treatment are vital for improving patient survival and quality of life. However, due to the limited number of cases, long-term outcomes remain uncertain, with most knowledge derived from individual case reports.In our specific case, lobular breast cancer cells were found confined to leiomyoma cells without clear endometrial implantation, suggesting limited uterine metastasis to the myomectomy border. This underscores the importance of thorough pathological examination to guide appropriate treatment decisions.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.Patient consentWritten informed consent for publication of their details was obtained from the patient.FundingNoneProtection of people and animals.Conflicts of interestThe authors declare that there is no conflict of interest." 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Here, we present a case of synchronous lobular breast cancer metastasis to a uterine myoma. Main symptoms and/or clinical findingsA 42-year-old infertile patient was admitted to the gynecology clinic with the complaints of meno/metrorrhagia. Ultrasound revealed a 5cm intramural myoma on the anterior wall of the uterus, leading to a myomectomy. The patient exhibited no symptoms related to breast cancer. Main diagnosisHistomorphological and immunohistochemical findings were indicative of breast-derived lobular carcinoma metastasis into leiomyoma. Therapeutic interventions and outcomesPositron emission tomography/computed tomography (PET/CT) scan revealed no pathological involvement beyond the breast and both axillary lymph nodes. The patient was diagnosed with stage IV breast lobular cancer and initiated chemotherapy treatment. Presently, the patient is undergoing regular monitoring at six-month intervals. ConclusionUterine metastasis from extragenital organ cancers is exceedingly rare. In this instance, lobular breast cancer metastasis was confined to the uterine myoma. Clinicians and pathologists should exercise caution regarding gynecological metastases in breast cancer cases." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Main symptoms and/or clinical findings" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Main diagnosis" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Therapeutic interventions and outcomes" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEs sumamente raro que el cáncer de mama haga metástasis en el útero, siendo el sangrado vaginal el síntoma más común. En este caso, informamos sobre una metástasis sincrónica de cáncer de mama lobulillar en un mioma uterino. Principales síntomas o hallazgos clínicosUna paciente infértil de 42 años acudió a la consulta ginecológica con síntomas de meno/metrorragia. La ecografía reveló un mioma intramural de 5cm en la pared anterior del útero, lo que llevó a realizar una miomectomía. La paciente no presentaba quejas relacionadas con el cáncer de mama. Diagnóstico principalLos hallazgos histomorfológicos e inmunohistoquímicos indicaron metástasis de carcinoma lobulillar de mama en leiomioma. Intervenciones terapéuticas y resultadosSe realizó una tomografía por emisión de positrones/tomografía computarizada, que no mostró afectación patológica más allá de la mama y los ganglios linfáticos axilares. La paciente fue diagnosticada con cáncer lobulillar de mama en estadio IV y se inició el tratamiento de quimioterapia. Actualmente, se continúa con el seguimiento cada 6 meses. ConclusiónEs excepcionalmente raro que el útero sea sede de metástasis sincrónicas de cánceres de órganos extragenitales. En este caso, la metástasis del cáncer de mama lobulillar estaba limitada al mioma uterino. Los médicos y patólogos deben tener precaución con las metástasis ginecológicas del cáncer de mama." 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Case report

Breast cancer with synchronous massive metastasis in uterine myoma: A case report and literature review

Cáncer de mama con metástasis masiva sincrónica en mioma uterino: reporte de un caso y revisión de la literatura

S. Eroglua,

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drsemraeroglu@gmail.com

Corresponding author.

, S. Celika, F. Tatlidilb, C. Caliskana, S.M. Aydina

a Samsun University, Department of Gynecology and Obstetrics, Samsun, Turkey

b Samsun University, Educational and Research Hospital, Pathology Clinic, Samsun, Turkey

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    "titulo" => "Breast cancer with synchronous massive metastasis in uterine myoma&#58; A case report and literature review"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">PET&#47;CT examination no parenchymal lesion with pathological F-18 FDG uptake was detected in both breasts&#46; Few lymph nodes&#44; the largest of which is approximately 2<span class="elsevierStyleHsp" style=""></span>cm in diameter on the right&#44; with selected fatty hiluses&#44; thought to be reactive&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Breast cancer ranks first in cancer-related deaths in women&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> In recent years&#44; early diagnosis and the appropriate treatment have increased the chance of survival&#46; While ductal breast cancer accounts for 75&#37; of all breast cancers&#44; invasive lobular type is responsible for 80&#37; of metastases to the genital organs&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">2&#44;3</span></a> The most common extragenital metastases to the gynecologic organs are found in the breast&#44; stomach and rectum&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> Extragenital neoplasms frequently metastasize to the ovary and vagina&#44; with concomitant uterine metastases being very rare&#44; detected in only 10&#37; of cases&#46; Here&#44; we report a case of breast cancer with synchronous massive metastasis in a uterine myoma&#44; discussing and reviewing the clinical diagnosis&#44; treatment course&#44; and pathological characteristics&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Information of patient</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 42-year-old infertile female patient presented to the Gynecology Clinic of Tertiary Hospital with heavy menstrual bleeding&#46; Ultrasonography revealed a 5<span class="elsevierStyleHsp" style=""></span>cm uterine fibroid originating from the fundus&#46; Due to anemia and menometrorrhagia&#44; myomectomy was decided upon&#46; Preoperative smear and endometrial biopsy results were benign&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Clinical findings</span><p id="par0015" class="elsevierStylePara elsevierViewall">In the review of myomectomy preparations&#44; infiltrates resembling solid layers and cell cords within the leiomyoma metastatic tumor were observed&#46; Immunohistochemical analysis revealed positivity for pancytokeratin&#44; GCDFP-15&#44; cytokeratin 7&#44; GATA 3&#44; estrogen receptor &#40;80&#37;&#41;&#44; and progesterone receptor &#40;50&#37;&#41;&#46; TFF-1 showed focal positivity&#46; c-erbB2 &#40;Score&#58; 0&#41;&#44; SMA&#44; Napsin A&#44; Inhibin&#44; SALL4&#44; Pax8&#44; cytokeratin 20&#44; p63&#44; CDX2&#44; CD10&#44; synaptophysin&#44; chromogranin&#44; CD56 were negative&#46; E-cadherin staining exhibited loss&#46; The Ki67 index was approximately 5&#37;&#46; These immunohistochemical findings were consistent with breast-derived lobular carcinoma metastasis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Timeline</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient had no significant personal or family medical history&#46; Obstetric-gynecological history revealed that the patient was in the reproductive period&#44; nulliparous&#44; and desiring pregnancy&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Diagnostic evaluation</span><p id="par0025" class="elsevierStylePara elsevierViewall">The patient underwent postoperative evaluation by general surgery and medical oncology&#46; Breast ultrasound revealed multiple simple cysts in the left breast at 3 o&#8217;clock&#44; measuring 10<span class="elsevierStyleHsp" style=""></span>mm in diameter&#44; and in the right breast at 9 o&#8217;clock&#44; measuring 9<span class="elsevierStyleHsp" style=""></span>mm in diameter&#46; Additionally&#44; a dense cystic lesion&#44; 4<span class="elsevierStyleHsp" style=""></span>mm in diameter&#44; was observed near the nipple at the 10 o&#8217;clock position on the right breast&#46; No circumscribed solid mass lesions were detected in either breast&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the right axilla&#44; lymphadenopathies measuring of 21<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>13 and 18<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm in size&#44; with thick cortex and cortical-medullary differentiation were noted&#46; However&#44; no pathologically enlarged lymph nodes or masses were in the left axillary area&#46; Positron emission tomography&#47;computed tomography &#40;PET&#47;CT&#41; examination revealed no parenchymal lesions with pathological F-18 FDG uptake in either breast&#46; A few lymph nodes&#44; the largest approximately 2<span class="elsevierStyleHsp" style=""></span>cm in diameter on the right&#44; exhibiting selected fatty hiluses and considered reactive&#44; showed F-18 FDG uptake slightly above the background activity&#46; No pathological findings were detected in the lung and mediastinum&#44; and bone scintigraphy showed no involvement&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Following the detection of breast cancer metastasis cells&#44; the patient&#39;s PET&#47;CT images were further evaluated &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Therapeutic interventions</span><p id="par0040" class="elsevierStylePara elsevierViewall">The patient underwent chemotherapy treatment with cyclophosphamide &#40;600<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> on Days 1&#8211;14&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>and doxorubicin &#40;60<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> on Days 1&#8211;14&#41; for two cycles&#44; followed by paclitaxel &#40;175<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> on Weeks 1 and 3&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Monitoring and results</span><p id="par0045" class="elsevierStylePara elsevierViewall">At the 6-month follow-up&#44; the patient remained well with no signs of disease progression&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Breast cancer stands as the most prevalent cause of cancer-related death in women&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> The primary sites of metastases of in breast cancer are commonly the lung&#44; bone&#44; liver&#44; brain and soft tissue&#46; However&#44; uterine metastasis represents a rare occurrence&#46; The hallmark symptom of uterine metastasis is abnormal vaginal bleeding&#44; typically observed in patients with endometrial metastases&#46; Conversely&#44; patients with exclusive myometrial metastases tend to remain asymptomatic&#46; The metastatic process is attributed to the loss of E-cadherin protein expression in the tumor cell membrane&#44; resulting in dysfunction of the E-cadherin&#8211;catenin complex&#44; critical for intercellular adhesion&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Ductal carcinoma constitutes 70&#8211;75&#37; of invasive breast cancer cases&#44; with lobular carcinoma comprising 5&#8211;20&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4&#44;6</span></a> In the study of Kondo et al&#46;&#44; ductal carcinoma was identified as the primary type in 9 out of 11 cases of metastatic breast cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> However&#44; metastatic spread of invasive lobular cancer &#40;ILC&#41; to bone is more frequent compared to invasive ductal carcinoma &#40;IDC&#41; and other metastatic organs&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> Metastasis to the female genital tract from extragenital tumors is uncommon&#44; primarily observed in cases of ILC if it occurs frequently&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4&#44;9</span></a> Mazur et al&#46; examined 325 cases of female genital tract metastases&#44; most frequently originating from colorectal &#40;37&#46;6&#37;&#41; and breast &#40;34&#46;9&#37;&#41; primaries&#44; followed by stomach &#40;5&#46;4&#37;&#41; and appendix &#40;2&#46;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> The ovary is the most commonly affected organ in genital metastases&#44; followed by the vagina&#44; with only a small percentage metastasizing to the uterus&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4&#44;5&#44;10</span></a> Uterine metastasis is indicative of a poor prognosis&#46; The ovary is more susceptible to metastasis due to its rich vascular and lymphatic network&#44; while the uterus metastasizes rarely due to widespread fibrous tissue and tight connections&#46; Uterine metastases are believed to primarily occur via retrograde lymphatic spread from ovarian metastases&#46; In cases of uterine metastasis&#44; the myometrium is typically more affected than the endometrium&#44; and metastasis to the myometrium is often asymptomatic&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> Metastases were observed in 63&#46;5&#37; of myometrial cases&#44; 32&#46;7&#37; in both myometrium and endometrium&#44; and 3&#46;8&#37; solely in the endometrium&#46; Uterine abnormal bleeding typically accompanies endometrial implantation&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In the literature&#44; uterine metastasis of breast cancer has been limited to case reports&#46; Due to the prevalence of uterine fibrous tissues and tight connections&#44; metastasis to the uterus is rare&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> Most reported cases involve patients previously diagnosed with breast cancer and undergoing tamoxifen treatment&#46; These patients typically exhibit hormone receptor positivity and develop uterine metastasis due to increased chemokine activity&#44; often diagnosed during routine gynecological examinations&#46; In our case&#44; benign breast examination findings were noted&#44; but lobular breast cancer metastasis cells were detected in the pathology preparations of a patient who underwent myomectomy for gynecological complaints&#46; To our knowledge&#44; this represents the first reported case of synchronous lobular breast cancer and uterine leiomyoma metastasis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Similar to our case&#44; Dirican et al&#46; published a case involving uterine metastasis after breast cancer&#46; They reported a 47-year-old woman with invasive ductal carcinoma&#44; progesterone receptor positive &#40;30&#37;&#43;&#41;&#44; and c-erbB2 negative&#46; The patient underwent partial mastectomy and axillary lymph node dissection&#46; During gynecological examination&#44; uterine cervix smear and probe curettage pathology were normal&#46; Total abdominal hysterectomy &#40;TAH&#41; and bilateral salpingo-oophorectomy &#40;BSO&#41; were performed upon detection of a solid 8&#46;5<span class="elsevierStyleHsp" style=""></span>mm area in the uterus on abdominal CT&#46; Metastasis of breast cancer was detected in the TAH and BSO specimens due to isolated CA 15-3 elevation&#46; Post-surgery&#44; a decrease in CA 15-3 levels was observed&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">13</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Isci et al&#46; reported a case involving a 48-year-old patient with invasive lobular cancer in the left breast&#44; diagnosed as estrogen receptor positive &#40;ER&#43;&#41; and P-HER2 negative&#44; with multiple bone and liver metastases at diagnosis&#46; The patient was deemed inoperable and received chemotherapy&#46; Initially&#44; a 10<span class="elsevierStyleHsp" style=""></span>cm leiomyoma was detected&#46; Subsequently&#44; upon presenting with abdominal tension and urinary incontinence 15 months later while on letrozole and ibandronate treatment&#44; a giant myoma extending to the xiphoid line was found&#46; TAH and BSO revealed metastases of breast cancer in both ovaries&#44; fallopian tubes&#44; abdominal washing fluid&#44; myometrium&#44; and the fibroid breast cancer&#46; No metastasis was detected in the endometrium&#46; The patient underwent cytotoxic therapy and was reported alive in the first postoperative year&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Tamoxifen&#44; used in patients with ER&#43; breast cancer&#44; has been associated with uterine leiomyoma enlargement and new myoma formation&#46; Studies indicate an increased risk of uterine sarcoma&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> Conversely&#44; the aromatase inhibitor letrozole inhibits estrogen in breast and adipose tissue and is as effective as tamoxifen in ER&#43; breast cancer in postmenopausal women&#44; without increasing the risk of endometrial cancer&#46; In the reported case&#44; contrary to the expected reduction in myoma with aromatase inhibitors&#44; myoma growth was considered a sign of metastasis&#44; prompting surgical intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The ovary is the genital organ most frequently affected by metastasis&#44; with the vagina ranking second&#46; Bilici et al&#46; documented a case of a postmenopausal woman with invasive ductal carcinoma who&#44; after undergoing mastectomy and lymph node dissection followed by chemotherapy and anastrozole treatment&#44; presented with abdominal pain six years post-diagnosis&#46; An MRI of the abdomen identified an 8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>cm nodular mass in the uterus&#44; suggestive of myoma uteri&#46; Following total TAH and BSO&#44; pathology confirmed the diagnosis as ovarian metastasis of invasive ductal carcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> Berger et al&#46; reported a case involving metastasis to both ovaries&#44; tubes&#44; the full thickness of the uterus&#44; and the cervix&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> while Kong et al&#46; described metastases to the uterus and cervix following lobular breast cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> Additionally&#44; Bogliolo et al&#46; presented a 78-year-old patient with an enlarged uterus and cervix identified during routine gynecological examination&#44; marking the first reported case of synchronous lobular breast cancer with cervical metastasis&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Given the rarity of uterine metastasis&#44; the literature contains only a limited number of cases&#46; Uterine metastases from breast cancer are uncommon and typically occur in patients at advanced stages of the disease&#44; often involving the entire layer of the uterus&#46; Research indicates that localized treatment of solitary metastases&#44; whether through surgery alone or in combination with radiotherapy&#44; can extend survival in patients with metastatic breast cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Differentiating between primary and metastatic uterine cancer is crucial due to differences in treatment approaches&#46; Biopsy and immunohistochemical staining are essential for suspicious lesions identified through imaging&#46; Early detection and treatment are vital for improving patient survival and quality of life&#46; However&#44; due to the limited number of cases&#44; long-term outcomes remain uncertain&#44; with most knowledge derived from individual case reports&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In our specific case&#44; lobular breast cancer cells were found confined to leiomyoma cells without clear endometrial implantation&#44; suggesting limited uterine metastasis to the myomectomy border&#46; This underscores the importance of thorough pathological examination to guide appropriate treatment decisions&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of human and animal subjects</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Patient consent</span><p id="par0115" class="elsevierStylePara elsevierViewall">Written informed consent for publication of their details was obtained from the patient&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0120" class="elsevierStylePara elsevierViewall">NoneProtection of people and animals&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest&#46;</p></span></span>"
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              "titulo" => "Diagn&#243;stico principal"
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              "titulo" => "Intervenciones terap&#233;uticas y resultados"
            ]
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              "titulo" => "Conclusi&#243;n"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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        5 => array:2 [
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          "titulo" => "Information of patient"
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          "titulo" => "Clinical findings"
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          "titulo" => "Timeline"
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          "titulo" => "Diagnostic evaluation"
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          "titulo" => "Therapeutic interventions"
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          "identificador" => "sec0035"
          "titulo" => "Monitoring and results"
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          "titulo" => "Discussion"
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          "titulo" => "Ethical disclosures"
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            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Confidentiality of data"
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            2 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
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          "identificador" => "sec0065"
          "titulo" => "Patient consent"
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          "titulo" => "Funding"
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          "titulo" => "Conflicts of interest"
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          "titulo" => "References"
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2024-01-29"
    "fechaAceptado" => "2024-02-20"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1842889"
          "palabras" => array:5 [
            0 => "Myoma metastasis"
            1 => "Breast cancer"
            2 => "Synchronous"
            3 => "Massive metastasis"
            4 => "Case report"
          ]
        ]
      ]
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1842888"
          "palabras" => array:5 [
            0 => "Met&#225;stasis de mioma"
            1 => "C&#225;ncer de mama"
            2 => "Sincr&#243;nico"
            3 => "Met&#225;stasis masiva"
            4 => "Reporte de caso"
          ]
        ]
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Metastasis of breast cancer to the uterus is an exceptionally rare occurrence&#44; typically presenting with vaginal bleeding as the predominant symptom&#46; Here&#44; we present a case of synchronous lobular breast cancer metastasis to a uterine myoma&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Main symptoms and&#47;or clinical findings</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 42-year-old infertile patient was admitted to the gynecology clinic with the complaints of meno&#47;metrorrhagia&#46; Ultrasound revealed a 5<span class="elsevierStyleHsp" style=""></span>cm intramural myoma on the anterior wall of the uterus&#44; leading to a myomectomy&#46; The patient exhibited no symptoms related to breast cancer&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Main diagnosis</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histomorphological and immunohistochemical findings were indicative of breast-derived lobular carcinoma metastasis into leiomyoma&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Therapeutic interventions and outcomes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Positron emission tomography&#47;computed tomography &#40;PET&#47;CT&#41; scan revealed no pathological involvement beyond the breast and both axillary lymph nodes&#46; The patient was diagnosed with stage IV breast lobular cancer and initiated chemotherapy treatment&#46; Presently&#44; the patient is undergoing regular monitoring at six-month intervals&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Uterine metastasis from extragenital organ cancers is exceedingly rare&#46; In this instance&#44; lobular breast cancer metastasis was confined to the uterine myoma&#46; Clinicians and pathologists should exercise caution regarding gynecological metastases in breast cancer cases&#46;</p></span>"
        "secciones" => array:5 [
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Main symptoms and&#47;or clinical findings"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Main diagnosis"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Therapeutic interventions and outcomes"
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          4 => array:2 [
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Es sumamente raro que el c&#225;ncer de mama haga met&#225;stasis en el &#250;tero&#44; siendo el sangrado vaginal el s&#237;ntoma m&#225;s com&#250;n&#46; En este caso&#44; informamos sobre una met&#225;stasis sincr&#243;nica de c&#225;ncer de mama lobulillar en un mioma uterino&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Principales s&#237;ntomas o hallazgos cl&#237;nicos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Una paciente inf&#233;rtil de 42 a&#241;os acudi&#243; a la consulta ginecol&#243;gica con s&#237;ntomas de meno&#47;metrorragia&#46; La ecograf&#237;a revel&#243; un mioma intramural de 5<span class="elsevierStyleHsp" style=""></span>cm en la pared anterior del &#250;tero&#44; lo que llev&#243; a realizar una miomectom&#237;a&#46; La paciente no presentaba quejas relacionadas con el c&#225;ncer de mama&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Diagn&#243;stico principal</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los hallazgos histomorfol&#243;gicos e inmunohistoqu&#237;micos indicaron met&#225;stasis de carcinoma lobulillar de mama en leiomioma&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Intervenciones terap&#233;uticas y resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una tomograf&#237;a por emisi&#243;n de positrones&#47;tomograf&#237;a computarizada&#44; que no mostr&#243; afectaci&#243;n patol&#243;gica m&#225;s all&#225; de la mama y los ganglios linf&#225;ticos axilares&#46; La paciente fue diagnosticada con c&#225;ncer lobulillar de mama en estadio IV y se inici&#243; el tratamiento de quimioterapia&#46; Actualmente&#44; se contin&#250;a con el seguimiento cada 6 meses&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Es excepcionalmente raro que el &#250;tero sea sede de met&#225;stasis sincr&#243;nicas de c&#225;nceres de &#243;rganos extragenitales&#46; En este caso&#44; la met&#225;stasis del c&#225;ncer de mama lobulillar estaba limitada al mioma uterino&#46; Los m&#233;dicos y pat&#243;logos deben tener precauci&#243;n con las met&#225;stasis ginecol&#243;gicas del c&#225;ncer de mama&#46;</p></span>"
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            "titulo" => "Principales s&#237;ntomas o hallazgos cl&#237;nicos"
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          2 => array:2 [
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            "titulo" => "Diagn&#243;stico principal"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">PET&#47;CT examination no parenchymal lesion with pathological F-18 FDG uptake was detected in both breasts&#46; Few lymph nodes&#44; the largest of which is approximately 2<span class="elsevierStyleHsp" style=""></span>cm in diameter on the right&#44; with selected fatty hiluses&#44; thought to be reactive&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">In the immunohistochemical study&#44; metastatic tumor cells were stained diffusely and strongly positive with cytokeratin 7&#46; No staining was observed in the cells of leiomyoma &#40;200&#215;&#41;&#46;</p>"
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                          "etal" => true
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                            0 => "S&#46; Guiu"
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            1 => "J&#46;G&#46; Azzopardi"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastasis of breast cancer to a uterine leiomyoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46;I&#46; Kondo"
                            1 => "S&#46; Yoshida"
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                            3 => "T&#46; Nagasaka"
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                    0 => array:2 [
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                      "titulo" => "Metastasis of breast cancer to an endometrial polyp&#44; the cervix and a leiomyoma&#58; a case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Razia"
                            1 => "K&#46; Nakayama"
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