Metastasis of lobular breast cancer to endometrial polyps with and without the presence of vaginal bleeding.

Metastasis to the female genital tract is unusual [1] but when it occurs the primary site is often the breast or the gastrointestinal tract. Themost commonly affected sites for genital tractmetastasis are the vagina and ovaries [1]. Endometrial metastases are even less common, typically occurring secondary to lobular breast cancer [2], which accounts for 6% of all breast cancers. In the present study, two patients with genital tract metastasis from a primary breast tumor are presented. The first patient was aged 40 years and had presented with bilateral lobular breast cancer; this was treated by mastectomy and lymphadenectomy. The patient received treatment with chemotherapy and tamoxifen. The patient developed bone and orbital metastasis, and hydronephrosis. Further, the patient experienced anomalous vaginal bleeding, with an endometrial polyp suspected; consequently, a hysteroscopy was performed (Fig. 1). Metastasis from lobular breast cancer was confirmed by biopsy. Owing the patientu0027s general level of health, no surgical treatment was performed. The second patient was aged 48 years and had presented with lobular breast cancer. This patient was treated with mastectomy, lymphnode dissection, chemotherapy, and radiotherapy. Subsequently, the patient received tamoxifen and remained asymptomatic for 18 months. While undergoing routine pelvic ultrasonography examination, an endometrial polyp was identified. A hysteroscopy was performed and three polyps were found; one was identified as being metastatic (Fig. 2); subsequently, a double oophorectomywas performed. Histopathologic analysis demonstratedmetastasis to one ovary and the endometrium, and to themyometrium in a different area. An iatrogenic polyp and endometrial hyperplasia were also identified. When a patient with breast cancer receives tamoxifen therapy it is important to be aware that if polyps, a thick endometrium, or abnormal bleeding are detected, and endometrial pathology is suspected, simple or complex atypical hyperplasia, or endometrioid adenocarcinoma should be considered likely causes, because tamoxifen is known to increase the risk of these pathologies [3] and these pathologies are a more common occurrence than breast metastasis. In the second patient, both metastasis and hyperplasia were influenced by tamoxifen therapy. Tamoxifen is a partial estrogen-receptor agonist and antagonist, depending on which tissue it acts in [4]. Endometrial metastases are rare but, among them, the most frequently occurring are lobular breast metastasis. Therefore, with advanced breast cancer patients, especially those with lobular breast cancer, the presence of abnormal bleeding or anomalous ultrasonography results should lead to the possibility ofmetastasis being considered.