Breast mass
Chief Complaint A 47 y/o female presented with a mass in the left breast Diagnosis Diagnosed as invasive lobular breast carcinoma. Patients underwent a mastectomy and axillary lymph node dissection & received chemotherapy. After 4 months patient complained of uterine bleeding. TVS shows thickened endometrium, Endometrial curettage was performed. Diagnosed as signet ring cell adenocarcinoma. Treatment What next should be done?
1)Metastases in the female genital tract occur from cancers that arise in various anatomic sites . The ovary is the most common metastatic site followed by the vagina, cervix, uterine corpus, and fallopian tubes. Among extra genital cancers metastasizing to the uterine corpus, breast is the most common primary site. Lobular carcinoma is the most common type of breast carcinoma that metastasizes to the uterus. 2) Signet-ring cells are vacuolated cells in which the nucleus is displaced and the vacuolated cytoplasm forms the image of a finger pore. The presence of signet cells in the presence of an endometrial tumour is primarily considered as the sign of a metastatic tumour. 3)In known breast cancer patients, a hormone-induced (tamoxifen) endometrial neoplasm should be excluded; and A consistent IHC is necessary to determine the original tumor.4) palliative hysterectomy for heavy uterine bleeding with laproscopy is good option for improvement of quality of life for rest of life.
Primary is uterine carcinoma with secondaries Breast mass mis also primary mass Hence control with chemoradiotherapy than think of radical hystrectomy and mastectomy followed by second sitting of chemotherapy and radiotherapy
Known case of lobular breast carcinoma, now endometrial curettage showing signet ring carcinoma Signet ring carcinoma is generally considered equivalent to or worse than poorly differentiated carcinoma, it is highly malignant tumor with very rapid increase in size and metastasis. It is completely different pathology as compared to lobular breast carcinoma which has much less potential to metastasis. Adv CT abdomen and pelvis PET CT while body to look for metastatic disease Further treatment based on evaluation of metastatic disease She may need, chemotherapy, radiotherapy or surgery
Primary signet ring adenocarcinoma of uterus is very rare and most commonly it is metastatic signet ring adenocarcinoma from breast or stomach . In this case - it is a case of metastatic disease of Carcinoma of breast with secondary signet ring adenocarcinoma in uterus . An oncologist consultation is required for plan of repeat cycles of chemotherapy. Also hormonal therapy- - should be started simultaneously Considering stage 4 disease- hysterectomy is not advised
? UTERINE CARCINOMA..WITH.. SECONDARIES.. BREAST.. NEED'S.. MANAGEMENT WITH.. ONCOLOGISTS OPINION..
UTERINE CARCINOMA WITH SECONDARIES METASTASIS. CHEMOTHERAPY AND AFTER PROPER ASSESSMENT AND EVALUATION RADICAL HYSTERECTOMY AND MASTECTOMY. RADIOTHERAPY MAY FOLLOW SURGICAL INTERVENTION. REGULAR MONITORING AND CONSTANT EVALUATION REQUIRED.
POSSIBLY METASTASES SECONDARY. TO LOBULAR. BREAST CARCONOMA NEEDS P. E. T..- CT AND COMPLETE HYSTERECTOMY AND SUBSEQUENT... MANAGEMENT
complete hysterectomy with bilateral salphingo oophorectomy followed by chemo/radiotherapy
Totals abdominal hysterectomy along with adjuvant chemo radiotherapy and follow up for both recurrence ca breast and endometrial carcinoma. Do MRI mammograms and pet scan for follow up and better prognosis.
Pry.signet cell uterine ca extremly rare.The case looks to be a metastatic disease ..ca breast(pry)with sec.in uterus. Needs chemo,radiotherapy or both.Medical Onchologist opinion
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