• Breast cancer
• Invasive lobular carcinoma
• Metastasectomy
• Metastasis
• Pancreas

• Female
• Humans
• Aged
• Carcinoma, Lobular/diagnosis
• Carcinoma, Lobular/pathology
• Adenocarcinoma
• Pancreatic Neoplasms/diagnosis
• Breast Neoplasms/pathology
• Carcinoma, Signet Ring Cell/diagnosis
• Carcinoma, Signet Ring Cell/pathology
• Pancreas/pathology

• ampulla of Vater
• breast cancer
• renal cell cancer

Breast cancer is the most common tumor in women, and about one-third of cases develop metastatic disease. However, metastatic breast cancer rarely invades the common bile duct (CBD) directly without involving the liver, and involvement of the gastrointestinal tract is rare. Cases of such metastases pose a particular diagnostic challenge.

A 55-year-old female presented to the Department of Gastroenterology with complaint of a 2 mo history of right upper abdominal pain accompanied by pain in the right back, aggravated after eating greasy diet. The patient had received a diagnosis of breast cancer 3 years prior. Physical examination showed obvious superficial protuberant erythema on the left neck and chest skin, with slight tenderness and burning sensation. Endoscopic retrograde cholangiopancre-atography showed an obstruction at the end of the CBD. Histopathology of the CBD and symptomatic skin biopsies showed positivity for cytokeratin 7 and trans-acting T-cell-specific transcription factor breast cancer biomarkers. A cancer embolus was also found in the skin vasculature. Accordingly, the diagnosis of breast cancer metastases to the skin and biliary ducts was made. A plastic biliary sent was placed, which relieved the right upper abdominal pain and protected against unnecessary hepatectomy surgery.

Although rare, biliary metastasis should be considered in patients with bile duct stenosis and a history of breast cancer.

• Breast cancer
• Common bile duct
• Metastases
• Plastic stent
• Prognosis
• Case report

Ovarian cancer often occurs distant metastasis to the peritoneum, liver, lungs, and lymph nodes. However, there has been no reported case of direct metastasis to the duodenal major papilla. We herein reported 72-year-old woman with history of ovarian cancer surgery 11 years ago presenting with obstructive jaundice. Abdominal CT showed a small mass in the distal bile duct. Forceps biopsy from the small mass was done under endoscopic retrograde cholangiography, and histologic examination revealed adenocarcinoma. Pancreaticoduodenectomy was performed and diagnosed immunohistochemically direct metastasis to the papilla from ovarian cancer. The duodenal major papilla is known to be rich in lymph vessels, and these lymph vessels are considered the likely pathway of metastasis in this case.

• ERCP
• Ovarian cancer
• ampullary metastasis
• obstructive jaundice

Renal cell carcinoma is the most common primary renal neoplasm in adults. Although renal cell carcinoma is known to spread to unusual sites, the ampulla of Vater is considered a rare site for metastasis. Here we present a case of renal cell carcinoma metastasized to the ampulla of Vater along with literature review. A 62-year-old Korean male had a history of hypertension and right-sided renal cell carcinoma diagnosed in September 2004, for which he underwent right radical nephrectomy in October 2004. The patient eventually underwent laparoscopic pylorus-preserving total pancreaticoduodenectomy in January 2017. The surgery was successful without postoperative complications. Previous studies have shown that surgical resection for solitary metastases of renal cell carcinoma can provide favorable survival rates. Our case report provides evidence that pancreaticoduodenectomy may be a treatment of choice for suitable patients with solitary renal cell carcinoma ampullary metastasis. A minimally invasive approach may result in early recovery of patient to be suitable for subsequent chemotherapy. Further evidence is needed to address the exact role of minimally invasive pancreaticoduodenectomy in renal cell carcinoma metastasized to the ampulla of Vater.

• Laparoscopic
• Pancreas metastasis
• Pancreaticoduodenectomy
• Renal cell carcinoma

Secondary tumours of the ampulla of Vater are rare. Underlying primary tumours, clinical presentation, macroscopic appearance, treatment strategies and outcome of secondary ampullary lesions have not been systematically analysed. The present case study reported a 57-year old patient with an ampullary metastasis from renal cancer and a literature review was performed in which a further 32 patients were included. The most common responsible primary tumours were malignant melanoma and renal clear cell carcinoma, followed by breast cancer. The time interval between the diagnosis of the primary tumour and the ampullary metastasis was highly variable, and may be as long as 10 years, particularly for renal cancer. Patients may present with unspecific abdominal discomfort, jaundice or upper gastrointestinal bleeding. The gross appearance was largely indistinguishable from that of a primary tumour. Lesions may present as polypoid or irregular, soft and friable tumour mass, in certain cases with superficial ulceration. In ~50% of cases, the ampullary metastasis was the only metastatic lesion, while in the remaining cases, the cancer had spread to one or more organs. The prognosis was generally poor. The management requires a multi-modal approach, including endoscopic, surgical and oncological procedure.

• ampulla of Vater
• ampullary tumour
• differential diagnosis
• histology
• metastasis
• secondary tumour

• Ampulla of Vater
• Breast Neoplasms
• Jaundice, Obstructive/etiology
• Neoplasm Metastasis

Invasive ductal carcinoma is the most common type of breast cancer and accounts for about 70-85% of all invasive breast carcinomas. It primarily metastasizes to the bone, lungs, regional lymph nodes, liver and brain. Most of breast cancer recurrence occurs within the first 5 years of diagnosis, particularly for ER negative disease. Gastrointestinal tract involvement is very rare and is detected in only 10% of all the cases, and it usually derives from lobular breast cancer rather than the much more common cell type of ductal breast cancer. Early diagnosis is very important because it enables prompt and adequate choice of treatment and improves patient’s long-term prognosis. In this report we describe an unusual case of obstructive jaundice caused by metastases from invasive ductal breast cancer to the lymph nodes of the hepatoduodenal ligament with extramural compression of the distal common bile duct and tumor invasion to the lumen of the duct. Our goal is to emphasize possible diagnostic pitfalls and increase the clinical awareness and the importance of intensive follow-up in patients with breast cancer, even years after the initial diagnosis.

• Bile duct obstruction
• Breast cancer
• Jaundice
• Metastasis
• Stent

• bile duct tumors
• breast cancer
• breast cancer metastases

• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/surgery
• Bile Ducts, Extrahepatic/pathology
• Breast Neoplasms/diagnosis
• Breast Neoplasms/surgery
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/surgery
• Cholangiopancreatography, Endoscopic Retrograde
• Diagnosis, Differential
• Female
• Humans
• Middle Aged
• Neoplasm Metastasis
• Prognosis
• Tomography, Emission-Computed

Acute bleeding from metastatic tumour of the papilla Vateri is an extremely rare case. In this report the case of a woman who suffered from complications after a metastatic tumour of the papilla is described. Seventeen years following resection of the kidney due to clear cell carcinoma the patient was admitted to the clinic because of massive bleeding (Forrest IB) to the upper digestive tract in the form of sanguineous vomiting. The conducted diagnostics revealed a bleeding tumour of the papilla Vateri. Endoscopic treatment could not effectively stop the bleeding. A surgical procedure was performed by Whipple's method. A histopathological examination showed a metastatic clear cell tumour of the kidney. The patient was discharged from hospital on the 8^th day following her admission and was also referred for further oncological treatment. The discussion is based on other cases of rare bleeding from the digestive tract within tumours of the bile duct and papilla Vateri.

• acute bleeding into upper gastrointestinal tract
• metastasis tumor
• papilla Vateri

• Breast Neoplasms/pathology
• Breast Neoplasms/surgery
• Carcinoma, Lobular/pathology
• Carcinoma, Lobular/secondary
• Carcinoma, Lobular/therapy
• Duodenal Neoplasms/pathology
• Duodenal Neoplasms/secondary
• Duodenal Neoplasms/therapy
• Female
• Humans
• Mastectomy
• Middle Aged
• Neoplasm Invasiveness