Late Cervical Recurrence of Invasive Lobular Carcinoma Ten Years After Primary Breast Cancer: A Case Report and Review of the Literature

TL;DR

A rare case of cervical recurrence of invasive lobular breast cancer ten years after initial treatment highlights the need for long-term gynecologic monitoring in breast cancer survivors.

Contribution

This case report emphasizes the underrecognized potential for late cervical metastasis in invasive lobular breast cancer and the diagnostic value of immunohistochemistry.

Findings

Cervical recurrence of invasive lobular breast carcinoma is exceptionally rare and often delayed by many years.

Immunohistochemistry remains crucial for distinguishing metastatic lobular carcinoma from primary cervical malignancies.

CDK4/6 inhibition combined with aromatase inhibition shows effectiveness in treating metastatic lobular breast cancer with gynecologic involvement.

Abstract

What are the main findings?
Cervical recurrence of invasive lobular breast carcinoma is exceptionally rare, and this case underscores the importance of considering metastatic disease in patients presenting with gynecologic symptoms, even many years after initial breast cancer treatment.The recurrence preserved the classic lobular immunohistochemical profile (ER/PR positive, HER2 negative, E-cadherin negative, GATA3 and CK7 positive), reinforcing the diagnostic utility of IHC in distinguishing metastatic lobular carcinoma from primary cervical malignancies.The patient experienced an unusually long disease-free interval of nine years before cervical and multi-site recurrence, highlighting the unpredictable and frequently delayed metastatic patterns of lobular breast carcinoma.PET-CT imaging showed a progressive and sustained treatment response, supporting the effectiveness of CDK4/6 inhibition combined with aromatase inhibition (ribociclib + letrozole) in metastatic lobular breast cancer with gynecologic involvement.

Cervical recurrence of invasive lobular breast carcinoma is exceptionally rare, and this case underscores the importance of considering metastatic disease in patients presenting with gynecologic symptoms, even many years after initial breast cancer treatment.

The recurrence preserved the classic lobular immunohistochemical profile (ER/PR positive, HER2 negative, E-cadherin negative, GATA3 and CK7 positive), reinforcing the diagnostic utility of IHC in distinguishing metastatic lobular carcinoma from primary cervical malignancies.

The patient experienced an unusually long disease-free interval of nine years before cervical and multi-site recurrence, highlighting the unpredictable and frequently delayed metastatic patterns of lobular breast carcinoma.

PET-CT imaging showed a progressive and sustained treatment response, supporting the effectiveness of CDK4/6 inhibition combined with aromatase inhibition (ribociclib + letrozole) in metastatic lobular breast cancer with gynecologic involvement.

What are the implications of the main findings?
This case emphasizes the importance of routine gynecologic assessment and multidisciplinary surveillance in long-term follow-up of patients with lobular breast carcinoma, given their distinct metastatic behavior and potential for very late recurrence.

This case emphasizes the importance of routine gynecologic assessment and multidisciplinary surveillance in long-term follow-up of patients with lobular breast carcinoma, given their distinct metastatic behavior and potential for very late recurrence.

Invasive lobular carcinoma (ILC) accounts for approximately 15% of breast cancers and the most common neoplasm in the female population. Cervical involvement is exceptionally rare and often underrecognized. This relationship is well-defined in the context of breast and ovarian cancer syndrome related to BRCA gene mutations. However, it is also observed in rare but underreported cases of cervical metastases originating from breast cancer. The objective of this manuscript is to describe a rare case of cervical recurrence of invasive lobular carcinoma and summarize comparable case to guide future gynecologic follow-up strategies. Therefore, we report the case of a 60-year-old woman who developed a late cervical recurrence of ILC ten years after her initial breast cancer diagnosis. The patient had previously undergone mastectomy for ER-positive, PR-positive, HER2-negative ILC, followed by five years of adjuvant endocrine therapy. She remained disease-free until presenting with post-menopausal bleeding, urinary symptoms, and acute renal failure. Pelvic examination and ultrasonography revealed an enlarged, indurated cervix with bilateral hydroureteronephrosis. Biopsy demonstrated a discohesive infiltrate consistent with metastatic lobular carcinoma, confirmed by immunohistochemistry (GATA3+, CK7+, ER/PR+, E-cadherin−, CK20−, CDX2−). Staging PET-CT showed additional metastases involving bone, peritoneum, and lymph nodes. The patient began systemic therapy with ribociclib plus letrozole, achieving radiologic improvement of the cervical lesion and abdominal disease. After a follow-up of several months, she maintains stable disease but has persistent chronic renal impairment secondary to obstructive uropathy. This case highlights the ability of ILC to recur after long latency and to metastasize to unusual gynecologic sites such as the cervix. We also review the literature on cervical recurrence from lobular carcinoma to emphasize the importance of gynecologic surveillance in breast cancer survivors and to identify areas that require further investigation.

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