Considered the most common malignancy in women in the United States and second leading cause of cancer death among women, breast cancer has had a shift in paradigm of treatment within the recent years and undertaken significant research for new targeted treatment with a more molecular driven approach which has led to increased survival rates amongst women diagnosed with early stage breast cancer. The risk of recurrence however persists overtime, particularly in hormone receptor positive breast cancer, which has demonstrated recurrence rates as late as 30 years after initial diagnosis. This leads to a higher need for increased awareness of late recurrence rates in early stage breast cancer patients and reminds us to be wary of any new findings that in other patients may be considered as benign. We present a case of a 67-year-old female with remote history of locally advanced hormone positive breast cancer in 2005 who underwent mastectomy with lymph node dissection followed by adjuvant chemotherapy, radiation, and endocrine therapy for at least 8 years who presented to our clinic 18 years after initial diagnosis with an enlarging nodule in her neck. Patient underwent a thyroid ultrasound which showed a suspicious thyroid nodule concerning for malignancy classified as TIRADS-5. Further systemic imaging via PET-Scan demonstrated surrounding cervical lymphadenopathy adjacent to the thyroid nodule with increased fluorodeoxyglucose (FDG) avidity. She proceeded to undergo a thyroid fine needle biopsy, which was suspicious for malignancy. A repeat thyroid fine needle biopsy was obtained this time confirming metastatic breast cancer. Considering the rarity of such event, we proceeded with further testing of biopsied tissue via cancer type ID, which confirmed presence of metastatic breast cancer in the thyroid. Patient was informed of now metastatic breast cancer diagnosis with plans to start Faslodex and Ibrance. Unfortunately, she developed rapid disease progression with hospitalization due to a recurrent malignant pericardial effusion suggestive of visceral crisis requiring initiation on palliative chemotherapy with Carboplatin and Gemcitabine. Patient has been tolerating systemic chemotherapy well with interval clinical decrease of more than 50% in size of her surrounding cervical lymphadenopathy and resolution of pericardial effusion. The incidence of thyroid metastatic disease from breast cancer is very rare accounting for only 0.2% of fine needle biopsy aspirations. The most common sites of breast cancer metastasis include lung, bone, liver, and brain. On the other hand, the most common primary malignancies that can cause metastasis to the thyroid are kidney, gastrointestinal tract, and lung. However, as of 2018 around 42 cases of metastatic breast cancer found in the thyroid had been reported and it was also noted that metastatic thyroid involvement of breast cancer could be associated with a poor prognosis. This case represents the importance of being aware of the risk of late recurrence in hormone positive breast cancers, which in turn should result in a lower threshold for thorough workup of common clinical findings in these patients.

The breast cancer, the second most common cancer in the world, is the most common among women, accounting for 25% of new cases of cancer each year. Statistics indicate an increase in global incidence. Important changes were signed in the last decade in the modalities of adjuvant and neoadjuvant treatments employed in the management of patients with breast cancer. These modifications include the surgical approach, radiotherapy techniques, chemotherapy agents, the routine use of hormonal therapy and the advent of molecular therapies target. All of them have contributed to the positive impact on survival of patients. In the world population, the median survival after five years is 61% to 85% in developed countries, by estimates of the World Health Organization. An increasing prevalence of women survivors are accompanied in late follow-up. However, even after decades, the risk of disease recurrence is maintained. This risk decreases significantly after the first two years of treatment, but it not annulled after more than a decade of recurrence-free survival of breast cancer. The risk factors and interventions that impact on early recurrence are well known, but it this information is not reproducible for late recurrence risk stratification. In this context, the analysis of hormonal receptors (HR), highlighted, estrogen receptors, is used by be related to the incidence of late recurrence of breast cancer. This study aimed to determine the impact of HR on the late tumor recurrence (RTT). The study consisted of data from all patients with RTT, which began monitoring for breast cancer at the University Hospital of Santa Maria between 2000 and 2009. Therefore were analyzed for cases (21) and controls (42) to obtain data on histology and tumor biology, methods of treatment used, and on the characteristics of RTT. The results demonstrated an increased risk RTT associated with advanced stages (moderate or high) of breast cancer (P = 0.01). However the risk of RTT was not associated with the HR profile (P = 0.61) or overexpression of HER-2 oncoprotein (P = 0.48). Also, it was observed that early recurrence risk reduction of breast cancer, obtained with adjuvant therapy, did not extend to the prevention of RTT, which indicates the need for specific routines to prevent RTT. In conclusion, those patients have a significant risk of RTT, regardless of the HR profile. Overall, these patients are not included in most recent studies involving reduction of late risk. / O câncer de mama, segundo tipo mais frequente de câncer no mundo, é o mais comum entre as mulheres, correspondendo por 25% dos casos novos de neoplasias a cada ano. As estatísticas indicam um aumento de sua incidência globalmente. Importantes modificações se firmaram na última década nas modalidades de tratamentos adjuvantes e neoadjuvantes, empregados no manejo das pacientes com câncer de mama. Essas modificações incluem a abordagem cirúrgica, as técnicas de radioterapia, as drogas empregadas na quimioterapia, o uso rotineiro de hormonioterapia e o advento de terapias com alvo molecular. Todas elas têm contribuído para o impacto positivo na sobrevida das pacientes. Na população mundial, a sobrevida média após cinco anos é de 61%, alcançando 85% em países desenvolvidos, conforme estimativas da Organização Mundial de Saúde (OMS). Uma prevalência cada vez maior de mulheres sobreviventes são acompanhadas em seguimento tardio. Contudo, mesmo após décadas, o risco de recorrência de doença se mantem. Esse risco reduz de forma significativa após os primeiros dois anos de tratamento, mas não se anula após mais de uma década de sobrevida livre de recorrência (SLR) do câncer de mama. Os fatores de risco e intervenções com impacto sobre a recorrência precoce são bem conhecidos, mas estas informações não são reprodutíveis para estratificação de risco de recorrência tardia. Neste contexto, a análise de receptores hormonais (RH), em destaque, os receptores de estrógenos (RE), é utilizada por guardar relação com a incidência de recorrência tardia do câncer de mama. Este trabalho buscou determinar o impacto destes RH sobre a recorrência tumoral tardia (RTT). O estudo reuniu os dados de todas as pacientes com RTT, que iniciaram acompanhamento por câncer de mama no Hospital Universitário de Santa Maria (HUSM) entre os anos de 2000 e 2009. Portanto, foram analisados casos (21) e controles (42) para obtenção de dados referentes à histologia e biologia tumoral, às modalidades de tratamentos empregados, e quanto às características da RTT. Os resultados demonstraram um risco maior de RTT relacionada a estágios avançados (moderado ou elevado) de câncer de mama (P=0,01). Contudo o risco de RTT não foi associado ao perfil de RH (P=0,61) ou da superexpressão da oncoproteína HER-2 (P=0,48). Ainda, observou-se que a redução de risco de recorrência precoce de câncer de mama, obtida com tratamento adjuvante, não se estendeu à prevenção da RTT, o que aponta a necessidade de rotinas especificas para prevenir RTT. Conclui-se que as pacientes apresentam significativo risco de RTT, independente do perfil de RH. Globalmente, estas pacientes não estão contempladas na maioria dos recentes estudos envolvendo redução de risco tardio.