Clitoral metastasis from ductal breast cancer revealing metastases in multiple sites and review of the literature

Abstract

Background: Clitoral metastasis from breast cancer is extremely rare.

Case: A 68-year-old woman with a 6-year previous history of breast cancer consulted her physician regarding a papillary and ulcerated clitoral lesion consistent with the appearance of vulvar squamous cell carcinoma. We analyzed the literature. Biopsy showed a ductal breast carcinoma with strongly positive estrogen and progesterone receptors. Magnetic resonance imaging of the pelvic area showed a second site on the right labium majus. Multiples metastases were detected. A right hemivulvectomy including the clitoris was performed, removing the 2 vulvar lesions. A nodule in the right breast and a cutaneaous lesion under the mastectomy scar were also removed. She refused chemotherapy, and initial hormonal therapy with anastrozole was switched to letrozol.

Conclusions: First, breast carcinoma on the vulva has 2 origins: primary breast carcinoma corresponding to ectopic breast tissue and--less frequently--breast cancer metastasis to the vulva. Second, the treatment of vulvar breast metastasis is the same as it would be on other sites: maximal reduction of the tumoral mass followed by chemotherapy-hormonal therapy.