Rare Sites of Metastases to the Breast and Integumentary System in Advanced Cervical Cancer at Initial Presentation in Eastern Uganda: A Case Report.
Julius Goodwill Nteziyaremye, Derrick Akandwanaho, Linda Lutada Adong
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Case in brief
A 72-year-old woman in Uganda presented after 13 months of intermittent postmenopausal bleeding and abnormal vaginal discharge, despite repeated treatment for presumed urinary and sexually transmitted infections. Examination showed a large, bleeding cervical tumour with vaginal and pelvic sidewall involvement, left breast masses, and nodules on the left thigh. Biopsies from the cervix, breast, and skin showed high-grade adenocarcinoma; breast and skin samples were p16-positive and ER- and PR-negative. She was diagnosed with stage IVB cervical adenocarcinoma with breast and integumentary metastases, as well as obstructive uropathy and probable deep venous thrombosis. She received palliation and died on the third day of admission.
What made this case unusual
Breast and cutaneous metastases were present at initial presentation of cervical adenocarcinoma, rather than the more commonly described distant sites of lung and supraclavicular lymph nodes.
Diagnostic / clinical pearl
In a patient with a cervical tumour and breast or skin lesions, biopsy and immunohistochemistry can help establish whether these lesions represent metastases from the cervical primary.
Why it matters
Recognising distant disease at uncommon sites can inform counselling about the extent of cancer and prognosis.