Cervical and uterine metastasis from carcinoma of breast diagnosed by PET/CT: an unusual presentation.

A 44-year-old apparently healthy woman presented with a 5-month history of intermittent vaginal bleeding. Clinical examination raised the suspicion of cervical neoplasia which was confirmed to be a metastatic adenocarcinoma on subsequent histopathological evaluation. An F-18 FDG PET/CT scan performed soon after revealed increased uptake in the cervix, extending upwards into the endometrial cavity. Additionally, small FDG avid spiculated soft tissue density masses were visualized in bilateral breast parenchyma, which proved to be lobular carcinoma on sonomammography followed by histopathology. Multiple lytic FDG avid skeletal metastases were also noted. Endometrial biopsy showed infiltrative malignant tumor with cytologic features similar to those observed in the breast biopsy specimen. The entire spectrum of findings pointed to a diagnosis of bilateral lobular carcinoma with uterine, cervical, and skeletal metastasis. Metastasis to the uterus and cervix from a breast primary is extremely rare. Most cases have been diagnosed in the follow-up of known cases of breast carcinoma. Our case is unique in that the patient, who had no prior history of breast carcinoma, was suspected to have a breast primary with cervical and uterine metastasis, based on the PET/CT findings.