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1
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Mubarak F, Kowkabany G, Popp R, Bansal S, Ahmed SH, Sharan S, Sukniam KB, Raikot SR, Jimenez PB, Popp K, Manaise HK, Gabriel E. Early Stage Breast Cancer: Does Histologic Subtype (Ductal vs. Lobular) Impact 5 Year Overall Survival? Cancers (Basel) 2024; 16:1509. [PMID: 38672591 PMCID: PMC11049226 DOI: 10.3390/cancers16081509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Histology is an important predictor of the behavior of breast cancer. We aim to study the impact of histology on the overall survival (OS) of breast cancer patients. We studied 11,085 breast cancer patients diagnosed with T1-T2 tumors, clinically node-negative and non-metastatic, from 2004 to 2019 included in the National Cancer Database. Kaplan-Meier curves, log-rank tests and Cox regression models were used to study the impact of histology and other variables on OS. In our patient population, 8678 (78.28%) had ductal cancer (IDC), while 2407 (21.71%) had lobular cancer (ILC). ILC patients were significantly more likely to be older, Caucasian, have a lower grade at diagnosis and be hormone receptor-positive compared to IDC patients. There was no statistically significant difference in the 5-year OS of early stage ductal (16.8%) and lobular cancer patients (16.7%) (p = 0.200). Patients of Hispanic and African American origin had worse OS rates compared to non-Hispanic and Caucasian patients, respectively. For node-positive disease, HER2+ tumors and triple-negative tumors, chemotherapy had a positive influence on OS (HR 0.85, 95% CI 0.77-0.93, p = 0.0012). Histology did not have a significant impact on the 5-year OS of early stage breast cancer patients.
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Affiliation(s)
- Fatima Mubarak
- The Aga Khan University Medical College, Stadium Road, P.O. Box 3500, Karachi 74800, Sindh, Pakistan
| | - Gabrielle Kowkabany
- Department of Chemical and Biological Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA;
| | - Reed Popp
- University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32610, USA;
| | - Shivam Bansal
- Government Medical College & Hospital, Block C, 1157-B, Chandi Path, 32B, Sector 32, Chandigarh 160047, India; (S.B.); (S.S.); (H.K.M.)
| | - Syeda Hoorulain Ahmed
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL 32608, USA;
| | - Seema Sharan
- Government Medical College & Hospital, Block C, 1157-B, Chandi Path, 32B, Sector 32, Chandigarh 160047, India; (S.B.); (S.S.); (H.K.M.)
| | - Kulkaew B. Sukniam
- Duke University Medical Center, 10 Duke Medicine Cir, Durham, NC 27710, USA;
| | | | | | - Kyle Popp
- Florida State University, 600 W College Ave, Tallahassee, FL 32306, USA;
| | - Harsheen K. Manaise
- Government Medical College & Hospital, Block C, 1157-B, Chandi Path, 32B, Sector 32, Chandigarh 160047, India; (S.B.); (S.S.); (H.K.M.)
| | - Emmanuel Gabriel
- Department of General Surgery, Division of Surgical Oncology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA;
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2
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Barbieri E, Caraceni G, Gentile D, Gavazzi F, Zerbi A, Tinterri C. A Rare Case of Duodenal Metastasis from Lobular Breast Cancer: From Diagnosis to Surgery. Case Rep Oncol 2023; 16:391-396. [PMID: 37384206 PMCID: PMC10294125 DOI: 10.1159/000530603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023] Open
Abstract
Gastrointestinal tract breast cancer (BC) metastases represent a rare event and generally originate from the lobular subtype. Duodenal involvement was rarely described in previous case series. Abdominal symptoms are extremely unspecific and misleading. Diagnosis is challenging, and it consists of a few mandatory steps from radiological examinations to histological and immunohistochemical analyses. Here, we presented the clinical case of a 54-year-old postmenopausal woman who was hospitalized for vomiting and jaundice, presenting increased level of liver enzymes and minimal main bile duct and choledocus dilatation at abdominal ultrasonography. She underwent breast-conserving surgery and axillary lymph node dissection for stage IIIB lobular BC, 5 years before. Metastatic infiltration of the duodenal bulb originating from lobular BC was proven histologically, through fine-needle aspiration during endoscopic ultrasonography. Treatment was established after multidisciplinary team evaluation, based on the clinical status and prognosis of the patient. Pancreaticoduodenectomy was performed, and final histological examination confirmed the secondary localization of lobular BC, infiltrating the duodenal and gastric wall, pancreas parenchyma, and surrounding tissues. No metastatic lymph nodes were found. After surgery, the patient underwent first line of adjuvant systemic treatment with fulvestrant and ribociclib. After a follow-up of 21 months, the patient was in good clinical condition, without signs of locoregional or distant recurrence. This report stressed on the importance of a tailored therapeutic approach. Although systemic therapy generally represents the preferred option, surgery should not be excluded if an oncological radical resection can be performed achieving acceptable locoregional disease control.
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Affiliation(s)
- Erika Barbieri
- Breast Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giulia Caraceni
- Breast Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Damiano Gentile
- Breast Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesca Gavazzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Corrado Tinterri
- Breast Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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3
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Bashir Hamidu R, Asif B, Lavu H, Kowalski T, Silver DP. Duodenal and Biliary Obstruction due to Extrinsic CompressionDuodenal and Biliary Obstruction due to Extrinsic Compression by Recurrent Lobular Breast Carcinoma: A Case Report. Case Rep Gastroenterol 2021; 15:869-876. [PMID: 34720837 PMCID: PMC8543313 DOI: 10.1159/000518874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/30/2021] [Indexed: 12/03/2022] Open
Abstract
Metastases to the gastrointestinal tract (GIT) from breast carcinoma are rare, detected in approximately <5% of all breast cancer patients. Invasive lobular carcinoma (ILC) is the most common histological type of breast cancer to metastasize to the GIT. We report a case of abdominal recurrence of ILC of the breast causing intra-abdominal contracture leading to extrinsic compression of the duodenum and periampullary biliary tree. Four years after the patient's diagnosis of a left breast pT1c, pN2, cM0 invasive lobular breast cancer, she presented with liver function tests consistent with biliary obstruction, and there was concern for a periampullary malignancy. Definitive diagnosis was achieved at laparotomy. This case demonstrates the importance of considering metastatic breast cancer as a potential cause of GI symptoms and radiological abnormalities affecting any part of the GIT of women with a previous history of lobular breast cancer. This case also highlights the effectiveness of chemotherapy in improving the survival and quality of life of these patients. Early recognition of this scenario enables prompt initiation of systemic therapy and avoids unnecessary surgical treatment. Despite the rarity, such patients will be encountered in clinical practice given the high prevalence of breast cancer. Moreover, the fact that the presenting symptoms of GI metastasis from breast cancer are usually not specific to the origin and mimic a primary intestinal disorder, health-care professionals beyond oncologists, especially gastroenterologists and primary care physicians, should be aware of this entity.
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Affiliation(s)
- Rukaiya Bashir Hamidu
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Bilal Asif
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Harish Lavu
- Department of Surgery, The Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thomas Kowalski
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Daniel P Silver
- Departments of Medical Oncology and Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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4
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Abdallah H, Elwy A, Alsayed A, Rabea A, Magdy N. Metastatic Breast Lobular Carcinoma to Unusual Sites: A Report of Three Cases and Review of Literature. J Med Cases 2021; 11:292-295. [PMID: 34434416 PMCID: PMC8383673 DOI: 10.14740/jmc3538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/18/2020] [Indexed: 12/13/2022] Open
Abstract
Invasive lobular carcinoma of the breast is the second most common type of invasive breast carcinoma. Invasive lobular carcinoma has an unusual pattern of metastases, which poses a diagnostic challenge for both clinicians and pathologists. We herein present three cases of breast invasive lobular carcinoma presented with metastasis to unusual sites, namely, uterus, colon and stomach. We recommend a higher index of suspicion in any case with breast cancer developing gastrointestinal tract or genital tract symptoms.
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Affiliation(s)
| | - Amira Elwy
- Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut Governorate, Egypt.,Pathology Department, Shefaa Al-Orman Hospital, Luxor, Egypt
| | - Aya Alsayed
- Medical Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Ahmed Rabea
- Medical Oncology Department, Shefaa Al-Orman Hospital, Luxor, Egypt
| | - Nesreen Magdy
- Pathology Department, Shefaa Al-Orman Hospital, Luxor, Egypt
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5
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Bolzacchini E, Nigro O, Inversini D, Giordano M, Maconi G. Intestinal metastasis from breast cancer: Presentation, treatment and survival from a systematic literature review. World J Clin Oncol 2021; 12:382-392. [PMID: 34131569 PMCID: PMC8173325 DOI: 10.5306/wjco.v12.i5.382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/23/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intestinal metastases from breast cancer (BC) arerare; available data depend mainly on case reports and case series.
AIM To conduct a review of the literature regarding presentation, diagnosis, treatment and survival of patients with intestinal metastasis from BC.
METHODS We identified all articles that described patients with intestinal metastasis (from duodenum to anum) from BC using MEDLINE (1975 to 2020) and EMBASE (1975 to 2020) electronic databases.
RESULTS We found 96 cases of intestinal metastasis of BC. Metastasization involved large bowel (cecum, colon, sigmoid, rectum) (51%), small bowel (duodenum, jejunum, ileum) (49%), and anum (< 1%). Median age of patients was 61-years. The most frequent histology was infiltrating lobular carcinoma followed by infiltrating ductal carcinoma. In more than half of patients, the diagnosis was made after the diagnosis of BC (median: 7.2 years) and in many cases of emergency, for bowel obstruction, bleeding or perforation. Diagnosis was achieved through endoscopy, radiological examination or both. In most of the cases, patients underwent surgery with or without systemic therapies. Survival of patients included in this review was available in less than 50% of patients and showed an overall median of 12 mo since diagnosis of the intestinal metastasis.
CONCLUSION Although, intestinal metastases of BC are considered a rare condition, clinicians should consider the possibility of intestinal involvement in case of abdominal symptoms even in acute setting and many years after the diagnosis of BC, especially in patients with a histology of lobular carcinoma.
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Affiliation(s)
- Elena Bolzacchini
- Department of Oncology, Ospedale Sant' Anna, ASST Lariana, Como 22100, Italy, Department of Medicine and Surgery, University of Insubria, Varese 21100, Italy
| | - Olga Nigro
- Department of Oncology, Ospedale di Circolo ASST-Sette Laghi, Varese 21100, Italy
| | - Davide Inversini
- Department of General Surgery, Ospedale Sant' Antonio Abate, ASST Lariana, Cantu' 22100, Italy
| | - Monica Giordano
- Department of Oncology, Ospedale Sant' Anna, ASST Lariana, Como 22100, Italy
| | - Giovanni Maconi
- Department of Biomedical and Clinical Sciences, Gastroenterology Unit, "Luigi Sacco" University Hospital, Milano 20157, Italy
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6
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Geada L, Kantor M, Mohan K, Weingrad D, Nasiff LS. An Uncommon Presentation of a Common Disease: A Review of Gastric Metastasis From Breast Carcinoma. Cureus 2020; 12:e11920. [PMID: 33425505 PMCID: PMC7785476 DOI: 10.7759/cureus.11920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Breast cancer is the most common cancer in women, and the leading cause of cancer-related deaths worldwide. Despite advances in screening and treatment modalities, distant metastasis still develops. Breast cancer metastasis to the gastrointestinal tract is very rare, therefore, its diagnosis, therapeutic strategies, and prognosis pose a clinical problem for clinicians. We summarize the current knowledge regarding the clinicopathological characteristics and diagnostic strategies for metastatic tumors in the stomach of breast origin.
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Affiliation(s)
- Luis Geada
- Department of General Surgery, Aventura Hospital and Medical Center, Miami, USA.,Department of General Surgery, Kendall Regional Medical Center, Miami, USA
| | - Micaella Kantor
- Department of Gastroenterology, Palm Springs Hospital, Miami, USA
| | - Karthik Mohan
- Department of Gastroenterology, Palmetto General Hospital, Miami, USA
| | - Daniel Weingrad
- Department of Surgical Oncology, Aventura Hospital and Medical Center, Miami, USA
| | - Luis S Nasiff
- Department of Gastroenterology, Palm Springs Hospital, Miami, USA
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7
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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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8
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Signorelli C, Pomponi-Formiconi D, Nelli F, Pollera CF. Single Colon Metastasis from Breast Cancer a Clinical Case Report. TUMORI JOURNAL 2018; 91:424-7. [PMID: 16459641 DOI: 10.1177/030089160509100509] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Metastatic involvement of the extrahepatic digestive system is rare. We here report the case of a 62-year-old woman who presented with a bowel obstruction related to a metastasis of breast cancer occurring 12 years after a mastectomy for lobular carcinoma. No other distant metastases were detected except for two nodules of 20 and 5 mm on the right chest wall. Biopsy of the larger nodule showed a lobular carcinoma. The patient underwent a right hemicolectomy and then received chemotherapy combined with letrozole, resulting in a partial response. The literature revealed only a few cases of breast cancer metastatic to the colon. Patients with known breast cancer, particularly of the lobular histological type, who present with specific or less specific abdominal symptoms or signs such a microcytic anemia, should be endoscopically explored in order to detect possible metastases of the primary breast tumor.
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Affiliation(s)
- Carlo Signorelli
- Medical Oncology Unit, Department of Oncology-Hematology, Belcolle Hospital, Viterbo, Italy.
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9
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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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10
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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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11
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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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12
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Lau CP, Hui EP, Chan ATC. Complete small bowel obstruction caused by metastasis from primary nasopharyngeal carcinoma. Rare Tumors 2009; 1:e7. [PMID: 21139901 PMCID: PMC2994435 DOI: 10.4081/rt.2009.e7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 06/29/2009] [Indexed: 12/19/2022] Open
Abstract
We here report the first case in the literature on a surgical emergency of complete small bowel obstruction caused by metastasis from nasopharyngeal carcinoma nine months after the primary tumor was treated with concurrent chemoradiation. The patient achieved prolonged survival with prompt surgical treatment followed by systemic chemotherapy.
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Affiliation(s)
- Chi Pan Lau
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, China
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13
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Balibrea JM, Cantero R, García-Calvo M, García-Pérez JC, Furió-Bacete V, Blanco J, Balibrea JL. Perianal metastases from lobular breast carcinoma. Clin Transl Oncol 2007; 9:606-609. [PMID: 17921110 DOI: 10.1007/s12094-007-0111-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast cancer gastrointestinal and soft tissue metastases are extremely rare. We present the case of a woman with perianal metastases from a primary lobular breast carcinoma 11 years after mastectomy and local radiotherapy.
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Affiliation(s)
- J M Balibrea
- Department of Surgery II, Hospital Clínico San Carlos, Complutense University, Ciudad Universitaria, Madrid, Spain.
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14
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Brookes M, MacVicar D, Husband J. Metastatic carcinoma of the breast: the appearances of metastatic spread to the abdomen and pelvis as demonstrated by CT. Br J Radiol 2007; 80:284-92. [PMID: 17038411 DOI: 10.1259/bjr/50066770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This review illustrates some CT appearances of metastatic breast cancer in the subdiaphragmatic abdomen and pelvis. Such manifestations are not uncommon in advanced disease and familiarity will enable confident diagnosis in patients at risk for metastatic disease.
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Affiliation(s)
- M Brookes
- Department of Radiology, St George's Hospital, Blackshaw Road, London SW17 0QT
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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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Idelevich E, Kashtan H, Mavor E, Brenner B. Small bowel obstruction caused by secondary tumors. Surg Oncol 2006; 15:29-32. [PMID: 16905310 DOI: 10.1016/j.suronc.2006.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 05/08/2006] [Indexed: 01/28/2023]
Abstract
Small bowel obstruction in an oncology patient is a common and serious medical problem which is associated with diagnostic as well as therapeutic dilemmas. While the condition is most commonly caused by postoperative adhesions and peritoneal carcinomatosis, other causes have been reported [Cormier WJ, Gaffey TA, Welch JM, et al. Linitis plastica caused by metastatic lobular carcinoma of the breast. Mayo Clinical Proceedings 1980;55:747-53; Clavien P-A, Laffer U, Torhos J, et al. Gastrointestinal metastases as first clinical manifestation of the dissemination of a breast cancer. European Journal of Surgical Oncology 1990;16:121-6; Bender GN, Maglinte DD, McLarney JH, et al. Malignant melanoma: patterns of metastasis to the small bowel, reliability of imaging studies, and clinical relevance. American Journal of Gastroenterology 2001;96:2392-400; Gatsoulis N, Roukounakis N, Kafetzis I, et al. Small bowel intussusception due to metastatic malignant melanoma. A case report. Technical Coloproctology 2004;8:141-3; Hung GY, Chiou T, Hsieh YL, et al. Intestinal metastasis causing intussusception in a patient treated for osteosarcoma with history of multiple metastases: a case report. Japanese Journal of Clinical Oncology 2001;31(4):165-7; Chen TF, Eardley I, Doyle PT, Bullock KN. Rectal obstruction secondary to carcinoma of the prostate treated by transanal resection of the prostate. British Journal of Urology 1992;70(6):643-7; Kamal HS, Farah RE, Hamzi HA, et al. Unusual presentation of rectal adenocarcinoma. Roman Journal of Gastroenterology 2003;12(1):47-50; Hofflander R, Beckes D, Kapre S, et al. A case of jejunal intussusception with gastrointestinal bleeding caused by metastatic testicular germ cell cancer. Digestive Surgery 1999;16(5):439-40]. One of these, reported thus far in only very few patients, is obstruction caused by secondary tumors, i.e. metastases from other organs to the small bowel wall. As cancer patients live longer with improved therapy, physicians are more likely to cope with rare phenomena of neoplasms, such as small bowel obstruction caused by secondary tumors. We hereby present a review of the relevant medical literature. The goal of this article is to define current knowledge on this phenomenon, with emphasis on its epidemiology and clinical characteristics, and to increase the awareness of the clinician treating cancer patients of such possibility.
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Gegúndez C, Paz JM, Mata I, Cao J, Conde J, Couselo JM, Avila S, Arija F. [Small bowel obstruction due to metastatic lobular carcinoma of the breast]. Cir Esp 2006; 77:102-4. [PMID: 16420897 DOI: 10.1016/s0009-739x(05)70817-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although breast cancer most frequently metastasizes to the bone, lung, pleura, liver, adrenal glands and brain, it can also affect other organs such as the small bowel and ovaries, especially if the type of cancer is infiltrating and lobular. We present a case of metastases to the small bowel and ovaries from pleomorphic type infiltrating lobular breast carcinoma presenting as intestinal obstruction. Barium transit study revealed a stenosis in the jejunum and another in the terminal ileum at the ileocecal valve area. A flat formation in the area of the ileocecal valve was observed on endoscopy but the results of biopsy were negative, a fairly frequent finding due to the absence of infiltration of the intestinal mucosa. Pathological and immunohistochemical study of the intestinal and ovarian surgical specimens confirmed the diagnosis of metastases from lobular carcinoma of the breast, which was corroborated by breast biopsy.
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Affiliation(s)
- Carlos Gegúndez
- Servicio de Cirugía General, Complexo Hospitalario Xeral-Calde, Lugo.
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Kobayashi T, Shibata K, Matsuda Y, Tominaga S, Komoike Y, Adachi S. A case of invasive lobular carcinoma of the breast first manifesting with duodenal obstruction. Breast Cancer 2005; 11:306-8. [PMID: 15550851 DOI: 10.1007/bf02984554] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lobular carcinoma of the breast presents with various clinical manifestations. Lobular carcinoma comprises about one fifth of cases of ductal carcinoma. Intestinal metastasis is dominant in cases of lobular carcinoma. Without a prior diagnosis of lobular carcinoma of the breast, the diagnosis of intestinal metastasis from breast cancer is difficult. A 52-year-old women underwent duodenogastrectomy for duodenal cancer. About 18 months later, she underwent mastectomy for lobular carcinoma of the breast. The duodenal cancer consisted mainly of malignant cells invading the submucosa that were identical to those in the breast. Immunohistochemical assays for estrogen receptor also confirmed breast cancer metastasis. Duodenal obstruction was the first sign of isolated metastatic lobular carcinoma of the breast in this case. The characteristic metastatic pattern of lobular carcinoma, which differs from that of ductal carcinoma, should be kept in mind to ensue proper diagnosis. Preceding breast surgery for lobular carcinoma should prompt investigation based on the typical metastatic pattern.
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Affiliation(s)
- Tetsuro Kobayashi
- Department of Surgery, Ikeda Municipal Hospital, 3-1-18, Jonan, Ikeda, Osaka 563-8510, Japan.E-mail:
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