Abstract:
: In most cases, metastatic breast cancer remains an incurable disease with a median overall survival of around two years. Nevertheless, the prognosis varies greatly depending on the presentation and genomic subtypes. We report the case of a 70-year-old patient; multipare; Menopaused ; hypertensive; diabetic with dyslipidemia under treatment; who consults for a gradually increasing breast mass that has been evolving for more than a year; with the notion of postmenopausal metrorrhagia a month ago without other associated signs, in particular no pelvic pain, no digestive or urinary signs; in whom clinical examination revealed a mass taking up the entire right breast fixed in both planes with inflammatory signs classed as C T4d N0 Mx with bleeding from the endocervix and vaginal nodules at the CDS. the anatomopathological study of the microbiopsy of the breast returned in favor of a grade I infiltrating breast carcinoma of luminal lobular type A SBR (IHC: 100% RO 100% HER2 negative) and for which the extension assessment is in favor of a right upper lobar pulmonary parenchymal nodule to be considered; with a suspicious heterogeneous uterine endometrial thickening supplemented by a biopsy of the vaginal nodules and a diagnostic hysteroscopy objectifying a diffuse endometrial hypertrophy with signs of atypia with performance of an endometrial curettage returning in favor of a secondary localization vaginal and endometrial breast lobular carcinoma with the same immunohistochemical profile as that of the breast. Lobular carcinomas, which represent 15% of breast cancers, have a particular development profile with in particular ovarian, peritoneal, retroperitoneal, meningeal metastases but also rare sites (gastric, bladder, vulva). Metastases to the uterus can be a diagnostic problem in a patient with bleeding. This is because cancer cells are mixed with normal endometrial stromal cells and may go unnoticed during curettage. The case of metastatic cancers from the outset; This situation is rare (4-6%). These cases pose, in addition to general treatment, the specific problem of the interest and optimal timing of locoregional treatment as well as the respective role of the surgeon or radiotherapist. Breast cancer is still a public health problem because of its frequency. Nevertheless, we note an improvement in his prognosis thanks to early detection and thanks to the improvement of therapeutic tools.
|