[Breast metastases of an ovarian adenocarcinoma]. / Métastase mammaire d'un adénocarcinome ovarien.

INTRODUCTION: Breast metastases are rare. Primary tumors are cutaneous, pulmonary, digestive and prostatic. A malignant tumor of the ovary is rarely responsible. OBSERVATION: A 69-year-old women presented a voluminous unilateral mastitis in a poly-metastatic context 3 years after the discovery of an ovarian adenocarcinoma. The anatomo-pathological examination confirmed the ovarian origin of the breast nodules observed. Progression was poor and the patient died 8 months after the first clinical signs in the breast. COMMENTS: The difficulty in differentiating a primary from a secondary carcinomatous mastitis is enhanced when the primary cancer is unknown. In our patient, the immunohistochemical study did not discriminate between the breast and ovarian origin. The diagnosis was finally made on the basis of standard histology and the anatomoclinical correlation. Since immunohistochemical examinations may not be specific enough, such as was the case in our patient, the anatomoclinical confrontation is essential.

[Uterine and ovarian metastases 28 years after the discovery of breast cancer]. / Métastases utérines et ovariennes 28 ans après la survenue d'un cancer du sein.

INTRODUCTION: Breast cancer seldom leads to uterine metastases, but more frequently spreads to the ovaries. OBSERVATION: A 72 year-old woman treated 28 years earlier for a breast cancer (conservative treatment and ovarian castration through radiotherapy) presented with metrorrhagia. The hysteroscopy and uterine curettage were normal. Three months later she presented with bone pains and pain along the course of the femoral nerve. The clinical examination revealed the existence of left axillary and sub-clavicle adenopathies. A biopsy of the lymph nodes showed a lobular adenocarcinoma with positive hormonal receptors. The clinical and biological state of the patient improved under treatment with tamoxifen and aredia. Eight months later the patient complained of pelvic pains. The ultrasound examination showed a pelvic tumour situated at the fundus of an enlarged uterus, as well as peritoneal effusion. The patient underwent a total hysterectomy and multiple biopsies that revealed diffuse metastases of a lobular adenocarcinoma spreading to the neck and the body of the womb, the mesosalpinx, the left ovary and the epiploon. The patient died less than a year after the first symptoms had appeared. DISCUSSION: Uterine metastases of extrapelvic origin are rare. Breast cancer is the first cause of this dissemination. It is generally invasive, lobular, and frequently spreads to the ovaries. In the case reported here, what is remarkable is the exceptionally long period between the discovery of a breast cancer and the apparition of metastases. Hence, in order to detect a primary or secondary ovarian or uterine cancer, it is important to emphasize the necessity of systematic pelvic examination in patients treated for breast cancer.