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Jones A, Kocher MR, Justice A, Navarro F. Colonic metastasis from infiltrating ductal breast carcinoma in a male patient: A case report. Int J Surg Case Rep 2018; 54:34-38. [PMID: 30513496 PMCID: PMC6280009 DOI: 10.1016/j.ijscr.2018.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/25/2018] [Accepted: 11/10/2018] [Indexed: 12/28/2022] Open
Abstract
Breast carcinoma gastrointestinal metastases occur in approximately 3% of cases. Metastatic gastrointestinal breast carcinoma is a rare phenomenon in men. Lobular carcinoma gastrointestinal metastases are more common than ductal. Metastatic breast carcinoma leaves the mucosal layer intact. Surgical resection may be necessary for diagnosis. Introduction A colonic metastasis from infiltrating breast ductal carcinoma is a rare phenomenon in the literature, especially in a male. Presentation of case We present a rare case of a 55-year-old male with a past medical history of breast cancer who presented with signs and symptoms of appendicitis. A computed tomography (CT) scan revealed acute appendicitis in addition to a 2.3 cm cecal mass that correlated with a hypermetabolic region on positron emission testing (PET) the previous year. Analysis of a previously biopsied axillary lymph node demonstrated infiltrating ductal carcinoma. After an appendectomy and a right hemicolectomy were performed, pathologic analysis of the specimen revealed metastatic ductal carcinoma to the cecum. Discussion Gastrointestinal metastases of breast carcinoma are rare with colonic metastases occurring in approximately 3% of these cases. At the time of diagnosis of these colonic metastases, the disease is often times multifocal in the gastrointestinal tract. Solitary gastrointestinal metastases are less common than both secondary primaries and benign processes. Biopsies obtained during colonoscopy are often non-diagnostic, mandating surgical excision and pathologic examination. Conclusion Although colonic metastases from a primary breast ductal carcinoma are rare, a low level of suspicion must be maintained in a patient with such a history presenting with abdominal symptoms.
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Affiliation(s)
- Ashley Jones
- Department of Surgery, Palmetto Healthcare System, University of South Carolina Medical School, 2 Medical Park Road, Columbia, SC 29203, United States.
| | - Madison R Kocher
- Department of Radiology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, United States.
| | - Ashlee Justice
- Department of Surgery, Palmetto Healthcare System, University of South Carolina Medical School, 2 Medical Park Road, Columbia, SC 29203, United States.
| | - Fernando Navarro
- Department of Surgery, Palmetto Healthcare System, University of South Carolina Medical School, 2 Medical Park Road, Columbia, SC 29203, United States.
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2
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Bushan K, Kammar P, Singh C, Advani S, Mahajan P. Infiltrating Lobular Breast Cancer Presenting as Isolated Gastric Metastasis: a Case Report. Indian J Surg Oncol 2018; 9:318-322. [PMID: 30287990 DOI: 10.1007/s13193-017-0705-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/12/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kirti Bushan
- Department of Surgical Oncology, Asian Cancer Institute, Mumbai, India
| | - Praveen Kammar
- Department of Surgical Oncology, Asian Cancer Institute, Mumbai, India
| | - Chandraveer Singh
- Department of Surgical Oncology, Asian Cancer Institute, Mumbai, India
| | - Suresh Advani
- Department of Medical Oncology, Asian Cancer Institute, Mumbai, India
| | - Praveen Mahajan
- Department of Pathology, Asian Cancer Institute, Mumbai, India
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3
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Schellenberg AE, Wood ML, Baniak N, Hayes P. Metastatic ductal carcinoma of the breast to colonic mucosa. BMJ Case Rep 2018; 2018:bcr-2018-224216. [PMID: 29804074 DOI: 10.1136/bcr-2018-224216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Breast cancer is the most common malignancy among women, while invasive ductal carcinoma is the most common type of invasive breast cancer. Metastatic spread to the colon and rectum in breast cancer is rare. This report describes a case of a 69-year-old woman with metastatic ductal breast cancer to the rectosigmoid, presenting as an incidental finding on screening colonoscopy. The breast carcinoma was first diagnosed 2 years prior. Colonic biopsies from colonoscopy confirmed metastatic adenocarcinoma consistent with a breast primary. Ultimately her clinical condition worsened as she developed malignant ascites, a small bowel obstruction, and new bone metastases, and the patient succumbed to her illness. Cases of metastatic breast cancer to the gastrointestinal tract have predominantly been lobular breast carcinoma. Increased awareness of colonic metastasis may lead to more accurate diagnosis and earlier systemic treatment.
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Affiliation(s)
- Angela E Schellenberg
- Department of General Surgery, Selkirk Regional Health Centre, Selkirk, Manitoba, Canada
| | - Melissa Lillian Wood
- Department of Surgery, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Nick Baniak
- Department of Pathology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Paul Hayes
- Department of Surgery, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
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4
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Colonic metastasis from breast carcinoma: a case report. World J Surg Oncol 2017; 15:124. [PMID: 28679405 PMCID: PMC5498884 DOI: 10.1186/s12957-017-1193-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colonic metastasis from breast carcinoma is very rare. Here, we report a case of colonic metastasis from breast carcinoma. CASE PRESENTATION The patient was a 51-year-old woman. She had upper abdominal pain, vomiting, and diarrhea, repeatedly. We performed abdominal contrast-enhanced computed tomography (CT) to investigate these symptoms. The CT scan revealed a tumor in the ascending colon with contrast enhancement and showed an expanded small intestine. For further investigation of this tumor, we performed whole positron emission tomography-computed tomography (PET-CT). The PET-CT scan revealed fluorodeoxyglucose uptake in the ascending colon, mesentery, left breast, and left axillary region. Analysis of biopsy samples obtained during colonoscopy revealed signet ring cell-like carcinoma. Moreover, biopsy of the breast tumor revealed invasive lobular carcinoma. Therefore, the preoperative diagnosis was colonic metastasis from breast carcinoma. Open ileocecal resection was performed. The final diagnosis was multiple metastatic breast carcinomas, and the TNM classification was T2N1M1 Stage IV. CONCLUSIONS We presented a rare case of colonic metastasis from breast carcinoma. PET-CT may be useful in the diagnosis of metastatic breast cancer. When analysis of biopsy samples obtained during colonoscopy reveals signet ring cell-like carcinoma, the possibility of breast cancer as the primary tumor should be considered.
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5
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Wang G, Wang T, Jiang J, Zhou L, Zhao H. Gastrointestinal tract metastasis from tubulolobular carcinoma of the breast: a case report and review of the literature. Onco Targets Ther 2014; 7:435-40. [PMID: 24672246 PMCID: PMC3964157 DOI: 10.2147/ott.s57831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Metastasis of breast cancer into the gastrointestinal tract happens rarely. The diagnosis of this kind of disease is difficult because of the nonspecific symptoms and the long interval between primary manifestations and recurrence. Awareness of this condition may lead to an accurate diagnosis and an earlier initiation of systemic treatment, thus avoiding unnecessary surgical intervention. In this paper, we report a rare case of a patient with tubulolobular carcinoma metastases to the colon, presenting with abdominal pain, discomfort, and weight loss. The patient underwent radical mastectomy and received postoperative radiotherapy and chemotherapy. Ten years later, she presented with gastrointestinal tract symptoms. Surgery combined with systemic treatment was chosen for the colon lesion. Immunohistochemical staining suggested a breast origin. The patient was still living 24 months after the diagnosis of the metastasis. This is the fourth case report in our literature review.
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Affiliation(s)
- Guixin Wang
- Department of Breast Surgery, The Second Affiliated Hospital of Dalian Medical University, Shahekou District, Dalian, Liaoning Province, People's Republic of China
| | - Tingjiang Wang
- Department of Breast Surgery, The Second Affiliated Hospital of Dalian Medical University, Shahekou District, Dalian, Liaoning Province, People's Republic of China
| | - Jian Jiang
- Department of Breast Surgery, The Second Affiliated Hospital of Dalian Medical University, Shahekou District, Dalian, Liaoning Province, People's Republic of China
| | - Luyao Zhou
- Department of Breast Surgery, The Second Affiliated Hospital of Dalian Medical University, Shahekou District, Dalian, Liaoning Province, People's Republic of China
| | - Haidong Zhao
- Department of Breast Surgery, The Second Affiliated Hospital of Dalian Medical University, Shahekou District, Dalian, Liaoning Province, People's Republic of China
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6
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Nikkar-Esfahani A, Kumar BG, Aitken D, Wilson RG. Metastatic breast carcinoma presenting as a sigmoid stricture: report of a case and review of the literature. Case Rep Gastroenterol 2013; 7:106-11. [PMID: 23626510 PMCID: PMC3617893 DOI: 10.1159/000348760] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Metastatic spread of breast carcinoma to the colon and rectum is rare. We report the case of a patient treated for lobular breast carcinoma presenting 17 years later with metastatic breast cancer of the colon. A 63-year-old lady with a past history of right-sided invasive lobular carcinoma of the breast presented with persistent diarrhoea. Colonoscopy with biopsies revealed a benign-looking stricture at the rectosigmoid junction. A CT scan of the abdomen and pelvis revealed a benign-looking stricture in keeping with a probable diverticular stricture. A Hartmann procedure was performed and histology revealed a metastatic lobular carcinoma with oestrogen and progesterone receptor-positive status. Treatment was commenced with letrozole and the patient remains well under clinical surveillance. In a patient with a history of breast carcinoma who presents with gastrointestinal symptoms the possibility of gastrointestinal tract spread should always be considered. Endoscopic diagnosis may be misleading with pathological diagnosis only being made following surgical resection. A history of breast carcinoma must be declared to the histopathologist following surgical resection so that an accurate diagnosis is made and appropriate treatment is commenced.
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Affiliation(s)
- A Nikkar-Esfahani
- Department of Colorectal Surgery, James Cook University, Hospital, Middlesbrough, UK
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7
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Matsuda I, Matsubara N, Aoyama N, Hamanaka M, Yamagishi D, Kuno T, Tsukamoto K, Yamano T, Noda M, Ikeuchi H, Tomita N, Hirota S. Metastatic lobular carcinoma of the breast masquerading as a primary rectal cancer. World J Surg Oncol 2012; 10:231. [PMID: 23114188 PMCID: PMC3500710 DOI: 10.1186/1477-7819-10-231] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/18/2012] [Indexed: 12/14/2022] Open
Abstract
Background Colorectal metastasis of lobular carcinoma of the breast is a diagnostic challenge. It may macroscopically simulate primary colon cancer or inflammatory bowel disease. In some cases, the interval between the primary breast cancer and metastatic colorectal lesions is so long that the critical records for diagnosis including history might be lost or missed. Case presentation Reported herein is a case of metastatic lobular carcinoma of the breast masquerading as a primary rectal cancer developed in a 62-year-old Japanese woman. The case initially presented as a circumferential rectal lesion, and information on the patient’s history of breast cancer was not noted. As the result of endoscopic biopsy, diagnosis of poorly differentiated rectal adenocarcinoma was made. The lesion was surgically resected after chemo-radiotherapy. Histopathological examination of the resected specimen with hematoxylin and eosin (HE) stain revealed a single-file arrangement of the tumor cells, reminiscent of lobular carcinoma of the breast. Immunohistochemical analysis revealed an immunophenotype consistent with lobular carcinoma of the breast. Because further review of the patient’s history revealed an occurrence of ‘poorly differentiated adenocarcinoma of the breast’, which she had experienced 24 years earlier, the final diagnosis of the lesion was made as rectal metastasis from lobular breast carcinoma. Conclusions Poorly differentiated adenocarcinoma of the colorectum is rarer than that of the stomach. Linitis plastica-type cancer of the colorectum is also rarer than that of the stomach. A lesson from the present case is that before we conclude a linitis plastica-type cancer of poorly differentiated type as a primary colorectal cancer, it is critical to exclude a possibility of metastatic colorectal cancer.
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Affiliation(s)
- Ikuo Matsuda
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
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8
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Metastatic breast cancer to the gastrointestinal tract: report of five cases and review of the literature. Int J Breast Cancer 2012; 2012:439023. [PMID: 23091732 PMCID: PMC3471430 DOI: 10.1155/2012/439023] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 09/04/2012] [Indexed: 12/17/2022] Open
Abstract
Luminal gastrointestinal (GI) metastases from breast cancer are rare, reports are fragmentary and poor. The purposes of this study are to assess the gastrointestinal involvement from breast cancer in a retrospective study at a single institution and reviewing the related literature. Between January 2007 and December 2011 a total of 980 patients with breast cancer were treated at our institution, patients' records and report database were analysed. Institutional Review Board approval was obtained for this study. A search of the literature using PubMed, CancerLit, Embase, was performed. Selected for the present review were papers published in English before June 2012. Five of 980 patients (0.5%) showed gastrointestinal metastases from breast cancer, 3 patients had gastric involvement, 1 jejunum, and 1 rectum. Reviewing the literature, 206 patients affected by gastrointestinal metastasis from breast cancer were identified: the most frequent site of metastasis was the stomach (60%). The majority of the patients underwent chemotherapy and endocrine therapy, someone surgery and radiotherapy. GI metastases from breast cancer are rare, but possible, and a very late recurrence can also occur. Cyto-histological diagnosis is mandatory, to differentiate GI metastases from breast cancer to other diseases and to allow an adequate treatment.
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9
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Spiridis C, Kambaroudis A, Ntinas A, Papadopoulos S, Papanicolaou A, Gerasimidis T. Intussusception of the small bowel secondary to malignant metastases in two 80-year-old people: a case series. J Med Case Rep 2011; 5:176. [PMID: 21569293 PMCID: PMC3113992 DOI: 10.1186/1752-1947-5-176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 05/11/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Small bowel intussusception is rare in adults and accounts for one percent of all bowel obstructions. Malignancy is the etiologic agent in approximately 50 percent of all cases. CASE PRESENTATION Our first patient was an 80-year-old Caucasian woman with signs and symptoms of intermittent bowel obstruction for the last 12 months. Pre-operative investigation by abdominal computed tomography scanning revealed an obstruction at the ileocecal valve. Exploratory laparotomy revealed an ileocecal intussusception. She underwent an enterectomy. Histological examination showed metastatic breast cancer (lobular carcinoma). Our patient had previously undergone a mastectomy due to carcinoma three years earlier.Our second patient was an 80-year-old Caucasian man with signs and symptoms of acute bowel obstruction. Pre-operative investigation by abdominal computed tomography scanning showed an intussusception in the proximal part of the small bowel. Exploratory laparotomy revealed a jejunojejunal intussusception. He underwent an enterectomy. Histological examination showed metastatic melanoma. Our patient had a prior history of a primary cutaneous melanoma which was excised two years ago. CONCLUSION Pre-operative determination of the etiologic agent of intussusception in the small bowel in adults is difficult. Although a computed tomography scan is very helpful, the diagnosis of intussusception is made by exploratory laparotomy and histological examination defines the etiologic agent. A prior malignancy in the patient's history must be taken under consideration as a possible cause of intussusception.
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Affiliation(s)
- Charalambos Spiridis
- 5th Surgical Clinic, Hippokrateion General Hospital, 49 Konstantinoupoleos str, PO 54642, Thessaloniki, Greece
| | | | - Achilleas Ntinas
- 5th Surgical Clinic, Hippokrateion General Hospital, 49 Konstantinoupoleos str, PO 54642, Thessaloniki, Greece
| | - Savvas Papadopoulos
- 5th Surgical Clinic, Hippokrateion General Hospital, 49 Konstantinoupoleos str, PO 54642, Thessaloniki, Greece
| | - Athanasios Papanicolaou
- Department of Pathologic Anatomy, Hippokrateion General Hospital, 49 Konstantinoupoleos str, PO 54642, Thessaloniki, Greece
| | - Thomas Gerasimidis
- 5th Surgical Clinic, Hippokrateion General Hospital, 49 Konstantinoupoleos str, PO 54642, Thessaloniki, Greece
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10
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Okido M, Seo M, Hamada Y, Kurihara S, Matsumoto K, Konomi H, Kato M, Ichimiya H. Metastatic breast carcinoma simulating linitis plastica of the colon: report of a case. Surg Today 2011; 41:542-5. [PMID: 21431489 DOI: 10.1007/s00595-009-4305-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 11/26/2009] [Indexed: 02/06/2023]
Abstract
A 48-year-old woman developed a mobile abdominal mass in the course of treatment for recurrent breast cancer. Imaging studies indicated linitis plastica of the colon. She underwent surgery because of the stenosis of the transverse colon. An examination of the resected specimen revealed a segmental stricture, thickening of the entire wall, and a granular mucosa resembling cobblestones. Microscopic findings of the colon lesion were very similar to those of her primary, invasive lobular carcinoma of the breast. Atypical cells showed immunoreactivity for cytokeratin-7, but not for cytokeratin-20. These findings suggested that the lesion of the colon was a colonic metastasis of breast cancer. Metastatic gastrointestinal diseases originating from breast carcinoma are unusual, and colonic metastases are especially rare. Although colon cancer may occur in patients with a history of breast cancer, metastatic colon cancer should be suspected if linitis plastica is detected.
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Affiliation(s)
- Masayuki Okido
- Department of Surgery, Hamanomachi Hospital, 3-5-27 Maizuru, Chuo-ku, Fukuoka, 810-8539, Japan
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11
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Isolated gastrointestinal metastasis of breast carcinoma: a case report. Case Rep Med 2010; 2010:615923. [PMID: 20592983 PMCID: PMC2892686 DOI: 10.1155/2010/615923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 04/27/2010] [Indexed: 12/23/2022] Open
Abstract
Purpose. Gastrointestinal tract is one of the rare locations for breast cancer metastasis. This paper shows such metastasis may occur even in the absence of breast metastasis in other more common locations.
Case Report. A 64-year old female was admitted to the hospital with abdominal discomfort and diarrhea. She had breast carcinoma treated 7 years previously with normal follow-up since. Colonoscopy showed hepatic flexure thickening that was confirmed to be breast metastasis. Staging investigations showed upper and lower gastrointestinal tract metastasis with negative findings elsewhere. Conclusion. Although more common causes for gastrointestinal symptoms should be excluded, however, a high index of suspicion of metastatic breast cancer is needed when such patients develop gastrointestinal symptoms.
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12
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Abstract
Lobular breast carcinoma represents 2-20% of infiltrative carcinomas of the breast. The incidence of extrahepatic gastrointestinal (GI) tract metastases observed in necropsy studies varies from 6% to 18% and the most commonly affected organ is the stomach, followed by colon and rectum [1-4]. Reported herein is the case of a 67-year-old woman who was primarily diagnosed and surgically treated for a lobular carcinoma of the breast 15 years ago and is now referred with back pain and right hydronephrosis caused by a metastasis in rectum. Frequently, the absence of specific symptoms of digestive metastases of breast cancer leads to a misdiagnosis of this pathology [5-7]. The treatment will be based on a detailed clinical history and histopathological findings. Metastases from breast cancer in GI tract tumours must be excluded in a patient with previous history of breast carcinoma, as in the case reported herein.
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13
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Colorectal breast carcinoma metastasis diagnosed as an obstructive colonic primary tumor. A case report and review of the literature. ACTA ACUST UNITED AC 2010; 33:1114-7. [PMID: 19896312 DOI: 10.1016/j.gcb.2009.05.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Revised: 05/19/2009] [Accepted: 05/20/2009] [Indexed: 12/22/2022]
Abstract
Common sites of colorectal breast carcinoma metastasis are bones, lungs, the central nervous system and the liver. Metastases in the gastrointestinal (GI) tract are rare and especially involve the stomach rather than the colon. Clinical or radiological features usually cannot differentiate them from a primary colorectal tumor, resulting in inappropriate treatment. In some cases, this lesion suggests multifocal spread of breast cancer with peritoneal carcinomatosis. Colorectal breast cancer metastasis is a rare finding and there is no consensus on the management of these lesions. The present case report describes a 69-year-old female with metastatic breast cancer presenting as an obstructive tumor of the transverse colon.
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14
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Yanagisawa K, Yamamoto M, Ueno E, Ohkouchi N. Synchronous rectal metastasis from invasive lobular carcinoma of the breast. J Gastroenterol Hepatol 2007; 22:601-2. [PMID: 17376062 DOI: 10.1111/j.1440-1746.2006.04671.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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15
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Nazareno J, Taves D, Preiksaitis HG. Metastatic breast cancer to the gastrointestinal tract: A case series and review of the literature. World J Gastroenterol 2006; 12:6219-24. [PMID: 17036400 PMCID: PMC4088122 DOI: 10.3748/wjg.v12.i38.6219] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Metastatic breast cancer involving the hepatobiliary tract or ascites secondary to peritoneal carcinomatosis has been well described. Luminal gastrointestinal tract involvement is less common and recognition of the range of possible presentations is important for early and accurate diagnosis and treatment. We report 6 patients with a variety of presentations of metastatic breast cancer of the luminal gastrointestinal tract. These include oropharyngeal and esophageal involvement presenting as dysphagia with one case of pseudoachalasia, a linitis plastica-like picture with gastric narrowing and thickened folds, small bowel obstruction and multiple strictures mimicking Crohn’s disease, and a colonic neoplasm presenting with obstruction. Lobular carcinoma, representing only 10% of breast cancers is more likely to metastasize to the gastrointestinal tract. These patients presented with gastrointestinal manifestations after an average of 9.5 years and as long as 20 years from initial diagnosis of breast cancer. Given the increased survival of breast cancer patients with current therapeutic regimes, more unusual presentations of metastatic disease, including involvement of the gastrointestinal tract can be anticipated.
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Affiliation(s)
- Jose Nazareno
- Department of Medicine (Gastroenterology), University of Western Ontario, 529 McGarrell Place, London, Ontario, N6G5L3, Canada.
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16
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Uygun K, Kocak Z, Altaner S, Cicin I, Tokatli F, Uzal C. Colonic metastasis from carcinoma of the breast that mimics a primary intestinal cancer. Yonsei Med J 2006; 47:578-82. [PMID: 16941751 PMCID: PMC2687742 DOI: 10.3349/ymj.2006.47.4.578] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Although the lung, liver, or bones are the most common location for distant metastases in breast cancer patients, metastases to the intestinal tract are very rarely recognized in the clinic. We will present an unusual case of colonic metastasis from a carcinoma of the breast that mimics a primary intestinal cancer, along with a through review of English language medical literature. Despite the fact that isolated gastrointestinal (GI) metastases are very rare and much less common than benign disease processes or second primaries of the intestinal tract in patients with a history of breast cancer, metastatic disease should be given consideration whenever a patient experiences GI symptoms.
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Affiliation(s)
- Kazim Uygun
- Department of Medical Oncology, Trakya University Hospital, 22030 Edirne, Turkey.
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17
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Nesher E, Schreiber L, Werbin N. Bauhin's ileocecal valve syndrome-a rare cause for small-bowel obstruction: report of a case. Dis Colon Rectum 2006; 49:527-9. [PMID: 16482419 DOI: 10.1007/s10350-005-0308-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Benign ileocecal valve hypertrophy is a rare cause for intestinal obstruction. We describe a 51-year-old female with clinical and imaging presentation of chronic small-bowel obstruction. The patient was operated on, and a limited thickening of the ileocecal bowel wall causing intestinal obstruction was found. A right hemicolectomy was performed. On microscopic examination, severe fibrosis with hypertrophied nerves was found without any additional findings of malignancy or inflammation. Review of the relevant literature is presented.
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Affiliation(s)
- Eviatar Nesher
- Department of Surgery A, Tel-Aviv Souraski Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Dhar S, Kulaylat MN, Gordon K, Lall P, Doerr RJ. Solitary Papillary Breast Carcinoma Metastasis to the Large Bowel Presenting as Primary Colon Carcinoma: Case Report and Review of the Literature. Am Surg 2003. [DOI: 10.1177/000313480306900914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Breast carcinoma has the potential for widespread dissemination. Spread to the lower gastrointestinal tract is infrequent, often multifocal, occurs in association with spread to other sites, and most commonly develops from lobular carcinoma. Solitary colorectal metastasis as the first and sole manifestation of spread is a rare occurrence and can be confused with primary intestinal malignancy. We present a case of metastatic papillary breast carcinoma presenting as a perforated primary colon cancer. Identity of the lesion was confirmed by direct histologic comparison of the resected tumor with prior breast specimen, cytokeratin expression, and the presence of estrogen receptors.
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Affiliation(s)
- Sorabh Dhar
- Department of Surgery, State University of New York at Buffalo, Buffalo, New York
| | - Mahmoud N. Kulaylat
- Department of Surgery, State University of New York at Buffalo, Buffalo, New York
| | - Kelly Gordon
- Department of Surgery, State University of New York at Buffalo, Buffalo, New York
| | - Purin Lall
- Department of Surgery, State University of New York at Buffalo, Buffalo, New York
| | - Ralph J. Doerr
- Department of Surgery, Rochester General Hospital, Rochester, New York
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19
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Daniels IR, Layer GT, Chisholm EM. Bowel obstruction due to extrinsic compression by metastatic lobular carcinoma of the breast. THE JOURNAL OF THE ROYAL SOCIETY FOR THE PROMOTION OF HEALTH 2002; 122:61-2. [PMID: 11989148 DOI: 10.1177/146642400212200118] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The commonest sites for breast cancer metastases are the bones, lungs, liver, pleura, adrenals and central nervous system. However, although other sites have been reported, solitary metastases to the gastrointestinal tract are extremely uncommon. Widely disseminated gastrointestinal metastases may be found in up to 20% of patients. Although only 15% of patients with breast cancer will have the lobular variety, these make up the majority of patients with solitary gastrointestinal metastases. Here we present three cases where solitary lobular breast cancer metastases have been demonstrated to be the cause of bowel obstruction. In two cases of duodenal obstruction was demonstrated and in the third colonic obstruction. In all cases a focal extrinsic compression was found.
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Affiliation(s)
- I R Daniels
- Department of Surgery, St Peter's Hospital, Chertsey, Surrey, England.
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Pla V, Buch E, Pallas A, Safont M, Roig J. Metástasis de carcinoma ductal infiltrante de mama simulando un cáncer de colon obstructivo primario. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)71975-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Bamias A, Baltayiannis G, Kamina S, Fatouros M, Lymperopoulos E, Agnanti N, Tsianos E, Pavlidis N. Rectal metastases from lobular carcinoma of the breast: report of a case and literature review. Ann Oncol 2001; 12:715-8. [PMID: 11432633 DOI: 10.1023/a:1011192827710] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Metastatic involvement of the gastrointestinal (GI) tract secondary to breast cancer is rare. Reported herein is the case of a 74-year-old woman with metastatic lobular breast carcinoma to the rectum presenting with obstruction. The breast tumour was diagnosed nine years prior to the presentation of rectal metastases. Endoscopy was repeated twice until a diagnosis was established. Examination of endoscopy material revealed infiltration of the rectum by malignant signet ring cells identical to those of the primary breast tumour. The patient did not respond to chemotherapy and underwent laparotomy with a defunctioning colostomy. Literature review revealed only a few more cases of metastatic breast carcinoma to the rectum. Awareness of this condition may lead to accurate diagnosis and early initiation of systemic treatment, thus avoiding surgical intervention.
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Affiliation(s)
- A Bamias
- Department of Medical Oncology, Ioannina University Hospital, Greece.
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22
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Cervi G, Vettoretto N, Vinco A, Cervi E, Villanacci V, Grigolato P, Giulini SM. Rectal localization of metastatic lobular breast cancer: report of a case. Dis Colon Rectum 2001; 44:453-5. [PMID: 11289296 DOI: 10.1007/bf02234749] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence of extrahepatic gastrointestinal metastases from breast cancer is reported in the literature only as necroscopy studies (6-18 percent); they usually originate from lobular or a mixed ductal-lobular subtype. Nonspecific presenting symptoms, death of the patients caused by other more frequent metastases, and variable radiographic features mimicking primary neoplasms cause a clinical underestimation of this pathology. We report here a case of rectal metastasis from a lobular carcinoma eight years after mastectomy.
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Affiliation(s)
- G Cervi
- Division of General Surgery, Hospital of Gardone Val Trompia, Italy
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23
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Yokota T, Kunii Y, Kagami M, Yamada Y, Takahashi M, Kikuchi S, Nakamura M, Yamauchi H. Metastatic breast carcinoma masquerading as primary colon cancer. Am J Gastroenterol 2000; 95:3014-6. [PMID: 11051411 DOI: 10.1111/j.1572-0241.2000.03238.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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24
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Winston CB, Hadar O, Teitcher JB, Caravelli JF, Sklarin NT, Panicek DM, Liberman L. Metastatic lobular carcinoma of the breast: patterns of spread in the chest, abdomen, and pelvis on CT. AJR Am J Roentgenol 2000; 175:795-800. [PMID: 10954469 DOI: 10.2214/ajr.175.3.1750795] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We determined the pattern of spread of metastatic lobular carcinoma in the chest, abdomen, and pelvis on CT. MATERIALS AND METHODS We identified 57 women (age range, 30-79 years; mean age, 57 years) with metastatic lobular carcinoma of the breast who underwent CT of the chest, abdomen, or pelvis between 1995 and 1998. Then two experienced oncology radiologists retrospectively reviewed 78 CT examinations of those patients to identify sites of metastatic disease and to identify complications caused by metastases. RESULTS Metastases were identified in bone in 46 patients (81%), lymph nodes in 27 patients (47%), lung in 19 patients (33%), liver in 18 patients (32%), peritoneum in 17 patients (30%), colon in 15 patients (26%), pleura in 13 patients (23%), adnexa in 12 patients (21%), stomach in nine patients (16%), retroperitoneum in nine patients (16%), and small bowel in six patients (11%). Eighteen patients (32%) had gastrointestinal tract involvement that manifested as bowel wall thickening. Hydronephrosis was present in six patients (11%). CONCLUSION Although lobular carcinoma metastasized to common metastatic sites of infiltrating ductal carcinoma, lobular carcinoma frequently metastasized to unusual sites, including the gastrointestinal tract, peritoneum, and adnexa. Gastrointestinal tract involvement was as frequent as liver involvement, appearing as bowel wall thickening on CT. Hydronephrosis was a complication of metastatic lobular carcinoma.
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Affiliation(s)
- C B Winston
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill Medical College, Office 862, 160 E. 53rd St., New York, NY 10022, USA
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25
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Abstract
Seven patients with metastatic breast cancer presenting as gastrointestinal primary are described. These included six gastric and one colonic lesions. None of the patients had known systemic metastases at the time of diagnosis. The mean age at presentation was 66.7 yr (range 55-78). Median interval between breast cancer and gastrointestinal metastasis diagnosis was 6 yr (range 0.25-12.5). Original breast cancer histology included infiltrating lobular cancer (n = 4), infiltrating ductal cancer (n = 1), and a mixed type (n = 2). All patients with gastric involvement presented with epigastric pain and early satiety; the patient with colonic involvement had heme-positive stool. In three cases of gastric tumor and the one case of colonic tumor presentation, a definitive diagnosis of metastatic breast cancer was only confirmed after surgical resection of a presumed primary gastric or colonic malignancy. In the other three cases, pathological diagnostic confirmation was obtained through endoscopic biopsies and comparison to breast biopsy material, and operative treatment was avoided in favor of systemic cytotoxic therapy. The diagnosis was confirmed through similarities between mammary and gastric histopathology with regard to growth pattern, hormone receptor status, or gross cystic disease fluid protein. A high level of suspicion for metastatic breast cancer and a detailed pathological analysis will help avoid unnecessary surgical treatment in patients with a history of mammary carcinoma presenting with a newly diagnosed gastrointestinal neoplasm.
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Affiliation(s)
- R E Schwarz
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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26
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Gifaldi AS, Petros JG, Wolfe GR. Metastatic breast carcinoma presenting as persistent diarrhea. J Surg Oncol 1992; 51:211-5. [PMID: 1434649 DOI: 10.1002/jso.2930510317] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients with breast carcinoma metastatic to the colon generally present with multiple symptoms, usually pain, vomiting, nausea, and ascites. We describe a patient who presented only with persistent diarrhea, underwent surgery for colon cancer, and, on pathological evaluation of the surgical specimen, was found to have metastatic breast cancer affecting the colon. Metastatic breast cancer should therefore be suspected in patients with a history of breast cancer and diarrhea of unknown cause that is not accompanied by other symptoms. Evaluating such patients by colonoscopy and biopsy would provide important information relevant to choosing between colon surgery and systemic therapy.
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Affiliation(s)
- A S Gifaldi
- Department of Surgery, St. Elizabeth's Hospital of Boston, MA 02135
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27
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Taal BG, den Hartog Jager FC, Steinmetz R, Peterse H. The spectrum of gastrointestinal metastases of breast carcinoma: II. The colon and rectum. Gastrointest Endosc 1992; 38:136-41. [PMID: 1568609 DOI: 10.1016/s0016-5107(92)70378-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a 15-year period at the Netherlands Cancer Institute, 17 patients were found with breast carcinoma metastatic to the colon or rectum or both. The presenting symptoms and signs were non-specific and included diarrhea, crampy pain, vomiting, and palpable tumor. Endoscopic examination, possible in only 10 of the 17 patients because of luminal obstruction, yielded a correct diagnosis in seven cases. Biopsy was confirmatory in five cases. Lesions metastatic to the colorectum originated predominantly in lobular carcinoma of the breast. Systemic hormonal or chemotherapy or x-irradiation, either alone or as an adjunct to surgery, produced a favorable response in over half the patients so treated.
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Affiliation(s)
- B G Taal
- Department of Gastroenterology, Netherlands Cancer Institute, Amsterdam
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