title: Abnormal uterine bleeding as a presentation of metastatic breast disease in a patient with advanced breast cancer.
abstract: BACKGROUND
  Extragenital carcinomas secondarily involving the uterus are very rare and they usually occur as a manifestation of widespread disease. When the metastases involve the endometrium in a diffuse, permeative pattern, sparing the glands, they may cause problems in the diagnosis.
  
  
  METHODS
  A case of metastatic carcinoma to the endometrium with a decidua-like pattern is reported. The patient had a history of breast carcinoma and presented with vaginal bleeding. The pathologic findings in the uterine curettings raised the differential diagnosis between metastatic breast carcinoma and non-neoplastic stromal lesions. The presence of nuclear atypia and mitotic activity along with the appropriate immunohistochemical findings revealed the neoplastic nature of the endometrial lesion and confirmed its origin from the breast.
  
  
  CONCLUSIONS
  Unusual uterine bleeding in a patient with breast cancer should alert the gynecologist to the possibility of metastatic breast disease. Furthermore, the metastasis to the uterus and to other organs of the genital tract can be considered as a preterminal event.
authors.affiliation: Department of Pathology, Aretaieion Hospital, University of Athens, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Karvouni
authors.forename: Katerina
authors.initials: K
authors.lastname: Papakonstantinou
authors.forename: Catherine
authors.initials: C
authors.lastname: Dimopoulou
authors.forename: Evi
authors.initials: E
authors.lastname: Kairi-Vassilatou
authors.forename: Dimitris
authors.initials: D
authors.lastname: Hasiakos
authors.forename: Constantinos G
authors.initials: CG
authors.lastname: Gennatas
authors.forename: Agatha
authors.initials: A
authors.lastname: Kondi-Paphiti
mesh_terms: D001706:Biopsy; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology*; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002352:Carrier Proteins / Q000032:analysis; D002584:Cervix Uteri / Q000473:pathology; D003656:Decidua / Q000737:chemistry / Q000473:pathology; D003937:Diagnosis, Differential; D004107:Dilatation and Curettage; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D005260:Female; D006023:Glycoproteins / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis / Q000473:pathology; D026901:Membrane Transport Proteins; D008875:Middle Aged; D018396:Mucin-1 / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D014592:Uterine Hemorrhage
chemical_list: D002272:Carcinoembryonic Antigen; D002352:Carrier Proteins; D006023:Glycoproteins; D026901:Membrane Transport Proteins; D018396:Mucin-1; C488892:PIP protein, human; D011960:Receptors, Estrogen