Unexplained Vaginal Bleeding in a Postmenopausal Woman Reveals Concurrent Invasive Ductal Carcinoma: A Case Report with Diagnostic Insights

Unexplained Vaginal Bleeding in a Postmenopausal Woman Reveals Concurrent Invasive Ductal Carcinoma: A Case Report with Diagnostic Insights | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Unexplained Vaginal Bleeding in a Postmenopausal Woman Reveals Concurrent Invasive Ductal Carcinoma: A Case Report with Diagnostic Insights Khalid Mohammed Al-Dhayani, Duaa Ahmad Irhayim, Nahed Bashory, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7171727/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Postmenopausal vaginal bleeding is a common clinical concern that mandates investigations to exclude endometrial malignancy. While breast cancer rarely presents with gynecological symptoms, metastasis to the uterus is a known, albeit uncommon, phenomenon. We present a case where the workup for vaginal bleeding incidentally revealed primary breast cancer. Case presentation A 55-year-old postmenopausal woman presented with a two-month history of unexplained vaginal bleeding. Pelvic ultrasound revealed endometrial thickening. During the comprehensive clinical evaluation, a firm, nontender mass was identified in the left breast. Subsequent mammography and biopsy confirmed Grade 3 invasive ductal carcinoma (IDC). The patient underwent total abdominal hysterectomy, which revealed a benign pathology (proliferative endometrium, adenomyosis, and leiomyoma), confirming that the bleeding was unrelated to the breast cancer. She was treated with a modified radical mastectomy and appropriate adjuvant therapy. Conclusions This case highlights a fortuitous diagnosis of breast cancer prompted by the investigation of an unrelated symptom. This underscores the critical importance of performing a thorough, multisystem clinical examination, even when a presenting symptom points toward a single organ system. A comprehensive approach can lead to the early detection of concurrent, clinically silent malignancies. Invasive ductal carcinoma Postmenopausal bleeding Breast cancer Endometrial pathology Case report Background Breast cancer is the most common malignancy among women globally and is a significant cause of cancer-related mortality. While typically presenting with palpable breast masses or mammographic abnormalities, it can, in rare instances, metastasize to distant organs, including the gynecological tract [ 1 , 2 ]. Metastasis to the uterus, cervix, or ovaries is an uncommon event, with invasive lobular carcinoma (ILC) having a greater propensity for gynecological metastasis than IDC [ 2 , 3 ]. However, cases of IDC involving these organs have been reported, often presenting with abnormal uterine bleeding, particularly postmenopausal bleeding [ 2 , 3 , 4 ]. Vaginal bleeding in postmenopausal women is a common gynecological concern, with a broad differential diagnosis that includes benign conditions such as endometrial atrophy, polyps, and hyperplasia, as well as malignant endometrial cancer [ 5 , 6 ]. While the most frequent cause of postmenopausal bleeding is genitourinary atrophy, ruling out malignancy is crucial, as approximately 90% of women diagnosed with endometrial cancer present with vaginal bleeding [ 6 ]. The interplay between breast cancer and gynecological pathology can be complex. Hormone receptor-positive breast cancers, especially those treated with hormonal therapies such as tamoxifen, can influence endometrial tissue, potentially leading to hyperplasia or even cancer [ 7 ]. In rare cases, breast cancer itself can directly metastasize to the uterus or cervix, presenting as a gynecological symptom such as vaginal bleeding [ 1 , 2 ]. This dual presentation, where a gynecological symptom may mask or coexist with a primary oncological diagnosis or its metastasis, underscores the importance of a thorough and multidisciplinary approach to patient management. This case highlights such a scenario, where a postmenopausal woman presented with unexplained vaginal bleeding, necessitating a comprehensive evaluation that ultimately identified both primary breast cancer and unrelated endometrial pathology. Case Presentation A 55-year-old, gravida 4 para 4, postmenopausal woman presented to our clinic with a two-month history of intermittent, moderate vaginal bleeding. She had been postmenopausal for five years and reported no associated pain, fever, or history of trauma. Her past medical history was unremarkable, with no prior gynecological or breast surgeries and no significant family history of malignancy. She was not on any hormonal therapy or anticoagulant medication. On physical examination, her vital signs were stable. The pelvic examination confirmed active vaginal bleeding from a slightly enlarged uterus, with no visible lesions on the cervix. Crucially, the breast examination revealed a firm, nontender mass measuring approximately 1 cm in the lower inner quadrant of the left breast, along with two small, palpable axillary lymph nodes. Initial investigations focused on the presenting complaint. A pelvic ultrasound revealed endometrial thickening but no adnexal masses. Given the concurrent breast findings, a diagnostic mammogram was performed, which revealed an irregular, spiculated mass highly suspicious for malignancy (BI-RADS 5). A core needle biopsy of the breast mass subsequently confirmed the diagnosis of Grade 3 IDC. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy to address vaginal bleeding and endometrial thickening. Gross and microscopic examination of the sample revealed a proliferative endometrium without atypia, adenomyosis, and a small leiomyoma. There was no evidence of malignancy or metastasis in the uterine specimen. For primary breast cancer, the patient was treated with left modified radical mastectomy and sentinel lymph node biopsy. Final histopathology confirmed a 14 mm Grade II (Nottingham score 6/9) IDC. The tumor was estrogen receptor (ER)-positive, progesterone receptor (PR)-positive, and HER2-positive. One of the thirteen lymph nodes was positive for metastasis. The surgical margins were clear. The final pathological stage was pT1c, pN1, or M0. The patient's postoperative course was uneventful. On the basis of the multidisciplinary tumor board recommendation, she was scheduled to receive adjuvant therapy, including hormonal therapy (aromatase inhibitors), HER2-targeted therapy (trastuzumab), and chemotherapy. Discussion This case presents a unique dual pathology: an IDC of the breast diagnosed concurrently with benign endometrial pathology that was the source of postmenopausal bleeding. The initial presentation of unexplained vaginal bleeding correctly raised suspicion for a gynecological malignancy. However, the definitive diagnosis underscores the importance of a comprehensive workup, as the bleeding was ultimately attributed to adenomyosis and a leiomyoma unrelated to breast cancer These findings can be contextualized within the literature on breast cancer metastasis to the gynecologic tract. While metastasis to these organs is a recognized phenomenon, it is considered rare, with the ovaries being the most common site [ 8 ]. ILC has a greater propensity for gynecologic metastasis than IDC does, making this case noteworthy [ 9 , 10 ]. A critical distinction in this case was the etiology of the presenting symptom. In many reported instances, postmenopausal bleeding is a direct consequence of breast cancer metastasis to the endometrium or cervix [ 8 , 11 ]. In contrast, the patient's bleeding was caused by coexisting benign conditions, an essential finding that separates this case from those where symptoms are a direct manifestation of metastatic disease. The differential diagnosis for postmenopausal vaginal bleeding is extensive, ranging from benign causes such as endometrial polyps and hyperplasia to malignancies of the endometrium, cervix, or ovaries. It also rarely includes metastases from extragenital primary cancers, such as those of the breast [ 8 ]. For this patient, the clinical, imaging, and histopathological findings were crucial in differentiating benign endometrial pathology from potential malignancy and, importantly, in establishing that vaginal bleeding was independent of newly diagnosed breast cancer. The hormone receptor positivity (ER/PR positive) of a patient's breast cancer is consistent with tumors that metastasize to the gynecologic tract, which are often ER positive [ 8 ]. This similarity highlights the necessity of histopathological confirmation to rule out metastasis, even when the clinical picture seems to fit. The key learning point from this case is the challenge posed by the concurrent presentation of a significant gynecological symptom with an undiagnosed primary malignancy in a different organ system. This emphasizes that symptoms such as postmenopausal bleeding, even if later found to be benign, should not distract from a thorough investigation of other systemic issues, particularly in the presence of palpable findings elsewhere. The successful management of both breast cancer via modified radical mastectomy and benign gynecological pathology via hysterectomy demonstrates the value of a systematic, multidisciplinary approach. The limitations of this report include its retrospective nature and single-center experience, which may limit its generalizability. Future research could explore the incidence of concurrent benign gynecological pathology in women who are newly diagnosed with breast cancer and present with abnormal vaginal bleeding. Conclusions In conclusion, this case demonstrates that postmenopausal bleeding in a patient with concurrent breast malignancy may be due to independent benign gynecological conditions rather than metastasis. This highlights the paramount importance of a comprehensive and systematic evaluation of all presenting symptoms to avoid premature diagnostic conclusions. While breast cancer metastasis to the gynecologic tract remains a possibility that must be excluded, clinicians should be aware that separate, benign pathologies can mimic metastatic disease presentation. The successful multidisciplinary management of both conditions underscores the importance of a holistic approach to patient care in complex clinical scenarios. Abbreviations • BI-RADS Breast Imaging Reporting and Data System • ER Estrogen receptor • HER2 Human epidermal growth factor receptor 2 • IDC invasive ductal carcinoma • ILC invasive lobular carcinoma • PR Progesterone Receptor Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Syria. Ethical approval was waived by the ethics committee because of the retrospective nature of the case report and the use of anonymized data. Verbal informed consent was obtained from the patient for the publication of this case report and any accompanying images. Consent for publication Verbal informed consent for publication was obtained from the patient. Competing interests The authors declare that they have no competing interests. Funding Information The authors declare that no funding was involved in the preparation of this case report. Author Contribution KMA conceptualized the study, conducted the literature search, wrote the original draft, and managed the submission. DAI and IA were responsible for data collection and patient follow-up. NMB was responsible for the diagnosis and provided expert evaluation. All authors read and approved the final manuscript. Acknowledgement The authors would like to express their gratitude to the patient for her consent and approval for the publication of this report. References Berger AA, Matrai CE, Cigler T, Frey MK. Palliative hysterectomy for vaginal bleeding from breast cancer metastatic to the uterus. Ecancermedicalscience. 2018;12:811. 10.3332/ecancer.2018.811 . Boudagh G, Kieft A, Choudhury MSR, Jacques SM, Miller S. Invasive ductal breast carcinoma metastasis to the uterine cervix presenting as heavy vaginal bleeding: a case report and a literature review. Cureus. 2024;16(6):e62523. 10.7759/cureus.62523 . Gomez N, McNeely M, Asirvatham JR, Akki AS. Micrometastatic breast cancer presenting as abnormal uterine bleeding: case report. Precis Cancer Med. 2020;3. 10.21037/pcm-20-5863 . Karvouni E, Papakonstantinou K, Dimopoulou C, Kairi-Vassilatou E, Hasiakos D, Gennatas CG, Kondi-Paphiti A. Abnormal uterine bleeding as a presentation of metastatic breast disease in a patient with advanced breast cancer. Arch Gynecol Obstet. 2009;279(2):199–201. 10.1007/s00404-008-0665-9 . Ghoubara A, Sundar S, Ewies A. Endometrial pathology in recurrent postmenopausal bleeding: observational study of 385 women. Climacteric. 2018;21:1–6. 10.1080/13697137.2018.1461825 . Ge S, Wang B, Wang Z, He J, Ma X. Common multiple primary cancers associated with breast and gynecologic cancers and their risk factors, pathogenesis, treatment and prognosis: a review. Front Oncol. 2022;12:840431. 10.3389/fonc.2022.840431 . Le Donne M, Alibrandi A, Ciancimino L, Azzerboni A, Chiofalo B, Triolo O. Endometrial pathology in breast cancer patients: effect of different treatments on ultrasonographic, hysteroscopic and histological findings. Oncol Lett. 2013;5:1305–10. 10.3892/ol.2013.1156 . Braun A, Reddy S, Cheng L, Gattuso P, Yan L. Clinicopathologic review of metastatic breast cancer to the gynecologic tract. Int J Gynecol Pathol. 2023;42(4):414–20. 10.1097/PGP.0000000000000920 . Liao H, Hou X, Chang X. Breast cancer metastasis to the reproductive system: report of 2 cases and literature review: a case report. Mol Clin Oncol. 2025;22(5):1–6. 10.3892/mco.2025.2839 . Wang X, Wei S. Breast cancer with cervix, lung and neck metastases: a case report and literature review. AME Case Rep. 2024;8:102. 10.21037/acr-24-36 . Sultana R, Nakayama K, Tsukao M, Nakamura K, Ishikawa M, Ishibashi T, et al. Metastasis of breast cancer to an endometrial polyp, the cervix and a leiomyoma: a case report and review of the literature. Oncol Lett. 2017;14(4):4585–92. 10.3892/ol.2017.6822 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7171727","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":494547508,"identity":"047011ce-e584-4f4c-a4e4-2928af0f0325","order_by":0,"name":"Khalid Mohammed Al-Dhayani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYBACewYeMwaGAgnGDff7Hxz4wMCQQFCLYQNPGgODgQTjzhtnGB/OIEaLwQGeY0CSgXH/jRxmYx6itNw+2/bgh4GF7LYbucekbdvs8vjZGxg/fMzBo+VcPrthj4GE8bYbeWnSuW3JxZI9B5glZ27Do+UMP5sEj4FE4rYbCWZALcyJG24ksDHz4tXC2yb5B6hlA0iLZVs9MVp4jknzgLXkGBszth0mrMWwhydNWgbolw03jiU+7Dl3PHFmz8FmvH6x5+Exk3xTUSe74X7zgQM/yqoT+9mbD374iEcLKmBkA5MNxKoHgT+kKB4Fo2AUjIKRAgAZ9VuSxlWmHwAAAABJRU5ErkJggg==","orcid":"","institution":"Amran University - General Medicine and Surgery","correspondingAuthor":true,"prefix":"","firstName":"Khalid","middleName":"Mohammed","lastName":"Al-Dhayani","suffix":""},{"id":494547510,"identity":"4e90ba6b-3669-4e9e-b436-c10935a378b3","order_by":1,"name":"Duaa Ahmad Irhayim","email":"","orcid":"","institution":"Al-Kalamoon University - Obs/Gyn","correspondingAuthor":false,"prefix":"","firstName":"Duaa","middleName":"Ahmad","lastName":"Irhayim","suffix":""},{"id":494547511,"identity":"1382bea3-8adb-4032-90b8-adfa5ffa928c","order_by":2,"name":"Nahed Bashory","email":"","orcid":"","institution":"Damascus University - Obs/Gyn","correspondingAuthor":false,"prefix":"","firstName":"Nahed","middleName":"","lastName":"Bashory","suffix":""},{"id":494547512,"identity":"57eda967-1872-45e6-be28-8e018c0ff08c","order_by":3,"name":"Ishrak M Alaboud","email":"","orcid":"","institution":"Al-Kalamoon University - Obs/Gyn","correspondingAuthor":false,"prefix":"","firstName":"Ishrak","middleName":"M","lastName":"Alaboud","suffix":""}],"badges":[],"createdAt":"2025-07-20 20:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7171727/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7171727/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96454320,"identity":"8562ae52-85bb-4396-baa7-975d30912106","added_by":"auto","created_at":"2025-11-21 10:02:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":373567,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7171727/v1/ba90b579-2fc5-4242-b750-0719ae365d3d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unexplained Vaginal Bleeding in a Postmenopausal Woman Reveals Concurrent Invasive Ductal Carcinoma: A Case Report with Diagnostic Insights","fulltext":[{"header":"Background","content":"\u003cp\u003eBreast cancer is the most common malignancy among women globally and is a significant cause of cancer-related mortality. While typically presenting with palpable breast masses or mammographic abnormalities, it can, in rare instances, metastasize to distant organs, including the gynecological tract [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Metastasis to the uterus, cervix, or ovaries is an uncommon event, with invasive lobular carcinoma (ILC) having a greater propensity for gynecological metastasis than IDC [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, cases of IDC involving these organs have been reported, often presenting with abnormal uterine bleeding, particularly postmenopausal bleeding [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eVaginal bleeding in postmenopausal women is a common gynecological concern, with a broad differential diagnosis that includes benign conditions such as endometrial atrophy, polyps, and hyperplasia, as well as malignant endometrial cancer [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While the most frequent cause of postmenopausal bleeding is genitourinary atrophy, ruling out malignancy is crucial, as approximately 90% of women diagnosed with endometrial cancer present with vaginal bleeding [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe interplay between breast cancer and gynecological pathology can be complex. Hormone receptor-positive breast cancers, especially those treated with hormonal therapies such as tamoxifen, can influence endometrial tissue, potentially leading to hyperplasia or even cancer [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In rare cases, breast cancer itself can directly metastasize to the uterus or cervix, presenting as a gynecological symptom such as vaginal bleeding [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This dual presentation, where a gynecological symptom may mask or coexist with a primary oncological diagnosis or its metastasis, underscores the importance of a thorough and multidisciplinary approach to patient management. This case highlights such a scenario, where a postmenopausal woman presented with unexplained vaginal bleeding, necessitating a comprehensive evaluation that ultimately identified both primary breast cancer and unrelated endometrial pathology.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 55-year-old, gravida 4 para 4, postmenopausal woman presented to our clinic with a two-month history of intermittent, moderate vaginal bleeding. She had been postmenopausal for five years and reported no associated pain, fever, or history of trauma. Her past medical history was unremarkable, with no prior gynecological or breast surgeries and no significant family history of malignancy. She was not on any hormonal therapy or anticoagulant medication.\u003c/p\u003e\u003cp\u003eOn physical examination, her vital signs were stable. The pelvic examination confirmed active vaginal bleeding from a slightly enlarged uterus, with no visible lesions on the cervix. Crucially, the breast examination revealed a firm, nontender mass measuring approximately 1 cm in the lower inner quadrant of the left breast, along with two small, palpable axillary lymph nodes.\u003c/p\u003e\u003cp\u003eInitial investigations focused on the presenting complaint. A pelvic ultrasound revealed endometrial thickening but no adnexal masses. Given the concurrent breast findings, a diagnostic mammogram was performed, which revealed an irregular, spiculated mass highly suspicious for malignancy (BI-RADS 5). A core needle biopsy of the breast mass subsequently confirmed the diagnosis of Grade 3 IDC.\u003c/p\u003e\u003cp\u003eThe patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy to address vaginal bleeding and endometrial thickening. Gross and microscopic examination of the sample revealed a proliferative endometrium without atypia, adenomyosis, and a small leiomyoma. There was no evidence of malignancy or metastasis in the uterine specimen.\u003c/p\u003e\u003cp\u003eFor primary breast cancer, the patient was treated with left modified radical mastectomy and sentinel lymph node biopsy. Final histopathology confirmed a 14 mm Grade II (Nottingham score 6/9) IDC. The tumor was estrogen receptor (ER)-positive, progesterone receptor (PR)-positive, and HER2-positive. One of the thirteen lymph nodes was positive for metastasis. The surgical margins were clear. The final pathological stage was pT1c, pN1, or M0.\u003c/p\u003e\u003cp\u003eThe patient's postoperative course was uneventful. On the basis of the multidisciplinary tumor board recommendation, she was scheduled to receive adjuvant therapy, including hormonal therapy (aromatase inhibitors), HER2-targeted therapy (trastuzumab), and chemotherapy.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case presents a unique dual pathology: an IDC of the breast diagnosed concurrently with benign endometrial pathology that was the source of postmenopausal bleeding. The initial presentation of unexplained vaginal bleeding correctly raised suspicion for a gynecological malignancy. However, the definitive diagnosis underscores the importance of a comprehensive workup, as the bleeding was ultimately attributed to adenomyosis and a leiomyoma unrelated to breast cancer\u003c/p\u003e\u003cp\u003eThese findings can be contextualized within the literature on breast cancer metastasis to the gynecologic tract. While metastasis to these organs is a recognized phenomenon, it is considered rare, with the ovaries being the most common site [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. ILC has a greater propensity for gynecologic metastasis than IDC does, making this case noteworthy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A critical distinction in this case was the etiology of the presenting symptom. In many reported instances, postmenopausal bleeding is a direct consequence of breast cancer metastasis to the endometrium or cervix [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In contrast, the patient's bleeding was caused by coexisting benign conditions, an essential finding that separates this case from those where symptoms are a direct manifestation of metastatic disease.\u003c/p\u003e\u003cp\u003eThe differential diagnosis for postmenopausal vaginal bleeding is extensive, ranging from benign causes such as endometrial polyps and hyperplasia to malignancies of the endometrium, cervix, or ovaries. It also rarely includes metastases from extragenital primary cancers, such as those of the breast [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. For this patient, the clinical, imaging, and histopathological findings were crucial in differentiating benign endometrial pathology from potential malignancy and, importantly, in establishing that vaginal bleeding was independent of newly diagnosed breast cancer. The hormone receptor positivity (ER/PR positive) of a patient's breast cancer is consistent with tumors that metastasize to the gynecologic tract, which are often ER positive [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This similarity highlights the necessity of histopathological confirmation to rule out metastasis, even when the clinical picture seems to fit.\u003c/p\u003e\u003cp\u003eThe key learning point from this case is the challenge posed by the concurrent presentation of a significant gynecological symptom with an undiagnosed primary malignancy in a different organ system. This emphasizes that symptoms such as postmenopausal bleeding, even if later found to be benign, should not distract from a thorough investigation of other systemic issues, particularly in the presence of palpable findings elsewhere. The successful management of both breast cancer via modified radical mastectomy and benign gynecological pathology via hysterectomy demonstrates the value of a systematic, multidisciplinary approach.\u003c/p\u003e\u003cp\u003eThe limitations of this report include its retrospective nature and single-center experience, which may limit its generalizability. Future research could explore the incidence of concurrent benign gynecological pathology in women who are newly diagnosed with breast cancer and present with abnormal vaginal bleeding.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, this case demonstrates that postmenopausal bleeding in a patient with concurrent breast malignancy may be due to independent benign gynecological conditions rather than metastasis. This highlights the paramount importance of a comprehensive and systematic evaluation of all presenting symptoms to avoid premature diagnostic conclusions. While breast cancer metastasis to the gynecologic tract remains a possibility that must be excluded, clinicians should be aware that separate, benign pathologies can mimic metastatic disease presentation. The successful multidisciplinary management of both conditions underscores the importance of a holistic approach to patient care in complex clinical scenarios.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; BI-RADS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBreast Imaging Reporting and Data System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; ER\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEstrogen receptor\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; HER2\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHuman epidermal growth factor receptor 2\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; IDC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003einvasive ductal carcinoma\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; ILC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003einvasive lobular carcinoma\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; PR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eProgesterone Receptor\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eThe study was conducted in accordance with the Declaration of Syria. Ethical approval was waived by the ethics committee because of the retrospective nature of the case report and the use of anonymized data. Verbal informed consent was obtained from the patient for the publication of this case report and any accompanying images.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eVerbal informed consent for publication was obtained from the patient.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding Information\u003c/h2\u003e\u003cp\u003eThe authors declare that no funding was involved in the preparation of this case report.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKMA conceptualized the study, conducted the literature search, wrote the original draft, and managed the submission. DAI and IA were responsible for data collection and patient follow-up. NMB was responsible for the diagnosis and provided expert evaluation. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to express their gratitude to the patient for her consent and approval for the publication of this report.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBerger AA, Matrai CE, Cigler T, Frey MK. Palliative hysterectomy for vaginal bleeding from breast cancer metastatic to the uterus. Ecancermedicalscience. 2018;12:811. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3332/ecancer.2018.811\u003c/span\u003e\u003cspan address=\"10.3332/ecancer.2018.811\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoudagh G, Kieft A, Choudhury MSR, Jacques SM, Miller S. Invasive ductal breast carcinoma metastasis to the uterine cervix presenting as heavy vaginal bleeding: a case report and a literature review. Cureus. 2024;16(6):e62523. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.62523\u003c/span\u003e\u003cspan address=\"10.7759/cureus.62523\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGomez N, McNeely M, Asirvatham JR, Akki AS. Micrometastatic breast cancer presenting as abnormal uterine bleeding: case report. Precis Cancer Med. 2020;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/pcm-20-5863\u003c/span\u003e\u003cspan address=\"10.21037/pcm-20-5863\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarvouni E, Papakonstantinou K, Dimopoulou C, Kairi-Vassilatou E, Hasiakos D, Gennatas CG, Kondi-Paphiti A. Abnormal uterine bleeding as a presentation of metastatic breast disease in a patient with advanced breast cancer. Arch Gynecol Obstet. 2009;279(2):199\u0026ndash;201. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00404-008-0665-9\u003c/span\u003e\u003cspan address=\"10.1007/s00404-008-0665-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhoubara A, Sundar S, Ewies A. Endometrial pathology in recurrent postmenopausal bleeding: observational study of 385 women. Climacteric. 2018;21:1\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/13697137.2018.1461825\u003c/span\u003e\u003cspan address=\"10.1080/13697137.2018.1461825\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGe S, Wang B, Wang Z, He J, Ma X. Common multiple primary cancers associated with breast and gynecologic cancers and their risk factors, pathogenesis, treatment and prognosis: a review. Front Oncol. 2022;12:840431. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fonc.2022.840431\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2022.840431\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLe Donne M, Alibrandi A, Ciancimino L, Azzerboni A, Chiofalo B, Triolo O. Endometrial pathology in breast cancer patients: effect of different treatments on ultrasonographic, hysteroscopic and histological findings. Oncol Lett. 2013;5:1305\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3892/ol.2013.1156\u003c/span\u003e\u003cspan address=\"10.3892/ol.2013.1156\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBraun A, Reddy S, Cheng L, Gattuso P, Yan L. Clinicopathologic review of metastatic breast cancer to the gynecologic tract. Int J Gynecol Pathol. 2023;42(4):414\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PGP.0000000000000920\u003c/span\u003e\u003cspan address=\"10.1097/PGP.0000000000000920\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiao H, Hou X, Chang X. Breast cancer metastasis to the reproductive system: report of 2 cases and literature review: a case report. Mol Clin Oncol. 2025;22(5):1\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3892/mco.2025.2839\u003c/span\u003e\u003cspan address=\"10.3892/mco.2025.2839\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang X, Wei S. Breast cancer with cervix, lung and neck metastases: a case report and literature review. AME Case Rep. 2024;8:102. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/acr-24-36\u003c/span\u003e\u003cspan address=\"10.21037/acr-24-36\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSultana R, Nakayama K, Tsukao M, Nakamura K, Ishikawa M, Ishibashi T, et al. Metastasis of breast cancer to an endometrial polyp, the cervix and a leiomyoma: a case report and review of the literature. Oncol Lett. 2017;14(4):4585\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3892/ol.2017.6822\u003c/span\u003e\u003cspan address=\"10.3892/ol.2017.6822\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Invasive ductal carcinoma, Postmenopausal bleeding, Breast cancer, Endometrial pathology, Case report","lastPublishedDoi":"10.21203/rs.3.rs-7171727/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7171727/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePostmenopausal vaginal bleeding is a common clinical concern that mandates investigations to exclude endometrial malignancy. While breast cancer rarely presents with gynecological symptoms, metastasis to the uterus is a known, albeit uncommon, phenomenon. We present a case where the workup for vaginal bleeding incidentally revealed primary breast cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 55-year-old postmenopausal woman presented with a two-month history of unexplained vaginal bleeding. Pelvic ultrasound revealed endometrial thickening. During the comprehensive clinical evaluation, a firm, nontender mass was identified in the left breast. Subsequent mammography and biopsy confirmed Grade 3 invasive ductal carcinoma (IDC). The patient underwent total abdominal hysterectomy, which revealed a benign pathology (proliferative endometrium, adenomyosis, and leiomyoma), confirming that the bleeding was unrelated to the breast cancer. She was treated with a modified radical mastectomy and appropriate adjuvant therapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case highlights a fortuitous diagnosis of breast cancer prompted by the investigation of an unrelated symptom. This underscores the critical importance of performing a thorough, multisystem clinical examination, even when a presenting symptom points toward a single organ system. A comprehensive approach can lead to the early detection of concurrent, clinically silent malignancies.\u003c/p\u003e","manuscriptTitle":"Unexplained Vaginal Bleeding in a Postmenopausal Woman Reveals Concurrent Invasive Ductal Carcinoma: A Case Report with Diagnostic Insights","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 09:06:09","doi":"10.21203/rs.3.rs-7171727/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"984f4816-65db-4061-9809-66fba0fb9db3","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-21T06:54:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-04 09:06:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7171727","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7171727","identity":"rs-7171727","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}