[Late metastases from breast cancer--report of two cases]

Breast cancer is amongst the commonest reasons for brain metastases involving 15-20% of the patients. Metastases discovered 10 or more years after the initial diagnosis of breast cancer are defined as late metastases and present a rare event. We present two cases of late brain metastases of breast cancer discovered 15 and 17 years after initial diagnosis.

In a 46-year old female patient a 5 x 6 cm lesion in the breast was observed and was histologically diagnosed to be a breast invasive ductal carcinoma. Mastectomy was performed (TNM grade - T2N1bM0) with postoperative radiotherapy (40 Gy for 20 days) combined with chemotherapy. All control investigations were normal for the next 17 years. During the last examination CA-15-3 levels were raised. CT scan revealed a lesion involving the frontal, temporal and parietal bones and the adjacent soft tissues as well as dura mater and the subdural space. Gross total resection was performed. In a 38-year old female patient a 3 cm lesion in the breast was observed and was histologically diagnosed to be a low differentiated invasive ductal breast carcinoma. Radical mastectomy was performed TNM grade (T2N1M0) with radio- and chemotherapy. For 13 years all control markers were negative. Last examination demonstrated increase of CA-15-3 levels. Due to complain of headache and nausea CT scan was performed showing a tumor lesion in the right frontal lobe. Gross total resection was performed.

In the presented cases we describe late brain metastasis from breast cancer 15 and 17 years after initial diagnosis. This observation is important because, regular followup for patients with breast cancer is 6-10 years. Obviously this approach in clinical practice could lead to mistakes and misdiagnosis of these rare lesions. Based on our experience we suggest that the follow-up, in patients treated for breast cancer, even with apparently total regression of the disease, should be extended beyond the routine period of 10 years and tumour markers should be investigated regularly. Metastasis in CNS should be taken into consideration in patients treated for breast cancer no matter the time from the initial diagnosis when clinical symptoms appear.