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Kabatnik S, Zheng X, Pappas G, Steigerwald S, Padula MP, Mann M. Deep visual proteomics reveals DNA replication stress as a hallmark of signet ring cell carcinoma. NPJ Precis Oncol 2025; 9:37. [PMID: 39910169 PMCID: PMC11799539 DOI: 10.1038/s41698-025-00819-7] [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: 07/22/2024] [Accepted: 01/17/2025] [Indexed: 02/07/2025] Open
Abstract
Signet Ring Cell Carcinoma (SRCC) is a rare and highly malignant form of adenocarcinoma with increasing incidence and poor prognosis due to late diagnosis and limited treatment options. We employed Deep Visual Proteomics (DVP), which combines AI-directed cell segmentation and classification with laser microdissection and ultra-high sensitivity mass spectrometry, for cell-type-specific proteomic analysis of SRCC across the bladder, prostate, seminal vesicle, and a lymph node of a single patient. DVP identified significant alterations in DNA damage response (DDR) proteins, particularly within the ATR and mismatch repair (MMR) pathways, indicating replication stress as a crucial factor in SRCC mutagenicity. Additionally, we observed substantial enrichment of immune-related proteins, reflecting high levels of cytotoxic T lymphocyte infiltration and elevated PD-1 expression. These findings suggest that pembrolizumab immunotherapy may be more effective than conventional chemotherapy for this patient. Our results provide novel insights into the proteomic landscape of SRCC, identify potential targets, and open up for personalized therapeutic strategies in managing SRCC.
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Affiliation(s)
- Sonja Kabatnik
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Xiang Zheng
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Georgios Pappas
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Sophia Steigerwald
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Matthew P Padula
- School of Life Sciences and Proteomics Core Facility, Faculty of Science, University of Technology Sydney, Ultimo, Australia.
| | - Matthias Mann
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany.
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Guío-Ávila JI, Soler-Perilla AY, Briceño-Morales X, Briceño-Morales C. Gastric signet ring cell adenocarcinoma metastatic to the breast. Systematic review of the literature, regarding a case. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2024; 75:4187. [PMID: 39470266 PMCID: PMC11584199 DOI: 10.18597/rcog.4187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 09/02/2024] [Indexed: 10/30/2024]
Abstract
Objectives To determine the general state of scientific evidence published in the last 20 years on gastric signet ring cell (SRC) adenocarcinoma metastatic to the breast, and present a case. Material and methods The case of a patient who attended a high-complexity reference institution in Bogotá for a breast metastasis from a gastric SRC adenocarcinoma is reported. A Systematic Review of the literature was carried out, including cohort studies, reports and case series of patients with gastric SRC adenocarcinoma metastatic to the breast, which will present information on the epidemiology, clinical, radiological and histopathological characteristics, and the treatment and prognostic of this disease. Results There were identified 363 references, twenty-six of which met the eligibility criteria. Gastric SRC adenocarcinoma metastatic to the breast predominated in the Asian continent (75.9%). The mean age at presentation was 42.5 years. In 62% (n=18) of cases this condition manifested clinically as a breast mass. From a radiological point of view, the majority of breast lesions presented as one or several nodules with suspicious characteristics (55.2%; n=16). In the biopsy of breast lesions, positivity for cytokeratin 7 and cytokeratin 20 occurred in 41.4% (n=12) and 37.9% (n=11) of cases, respectively. Only nine patients (31%) underwent any type of breast surgery. There is a lack of information on the treatment and prognosis of gastric SRC adenocarcinoma metastatic to the breast. Conclusions The frequency of cases of gastric SRC adenocarcinoma metastatic to the breast published in the last 20 years is low. The general practitioner and the gynecologist could be the first medical professionals to face this rare condition, so knowing it and suspecting it is essential, especially if we take into account that the median overall survival of these patients is low.
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Affiliation(s)
- José Ismael Guío-Ávila
- Profesor Titular, Departamento de Ginecología y Obstetricia, Hospital de San José de Bogotá, Fundación Universitaria de Ciencias de la Salud. Bogotá (Colombia)
| | - Adriana Yulieth Soler-Perilla
- Residente de cuarto año de Ginecología y Obstetricia, Hospital de San José de Bogotá, Fundación Universitaria de Ciencias de la Salud. Bogotá (Colombia)
| | - Ximena Briceño-Morales
- Especialista en Mastología, Instituto Nacional de Cancerología. Bogotá (Colombia); Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad Nacional de Colombia. Bogotá (Colombia)
| | - Clara Briceño-Morales
- Especialista en Cirugía Oncológica. Grupo de Investigación en Ciencias Quirúrgicas, Universidad Tecnológica de Pereira. Pereira (Colombia); Institución Universitaria Visión de las Américas. Pereira (Colombia)
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Liu JH, Dhamija G, Jiang Y, He D, Zhou XC. Gastric cancer metastatic to the breast: A case report. World J Gastrointest Oncol 2024; 16:3331-3340. [PMID: 39072150 PMCID: PMC11271788 DOI: 10.4251/wjgo.v16.i7.3331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/01/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Metastatic breast cancer originating in the gastrointestinal tract is a rare occurrence. The limited number of cases has resulted in incomplete understanding of the disease, making it challenging to differentiate from primary breast cancer. While clinical history and immunohistochemical studies can aid in distinguishing between the two, the management principles and pathogenesis of gastrointestinal metastatic breast cancer remain controversial. The scarcity of data has hampered comprehensive knowledge. Our objective is to shed light on this rare disease through our case study. CASE SUMMARY Here, we report a case of breast metastasis from gastric cancer in a 43-year-old woman. This patient was admitted to our hospital with complaints of discomfort in the upper and middle abdomen persisting for two months, as well as black stools for over ten days. She underwent radical distal gastrectomy for gastric cancer, followed by postoperative chemotherapy. Three years later, the patient developed bilateral breast nodules. Imaging studies indicated a high probability of malignancy. She subsequently underwent a right modified radical mastectomy and excision of a left breast mass. Postoperative pathology revealed the right breast tumor was consistent with primary gastric cancer. CONCLUSION We present a case of breast metastasis from gastric cancer to contribute to the limited foundation of research into this rare disease.
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Affiliation(s)
- Jia-Hui Liu
- Department of Urology, The Dingli Clinical College of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
| | - Gaurav Dhamija
- School of International Studies, Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Yi Jiang
- Department of Pathology, The Dingli Clinical College of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
| | - Dan He
- Department of Gastroenterology, The Dingli Clinical College of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
| | - Xiao-Cong Zhou
- Department of Colorectal Surgery, The Dingli Clinical College of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
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Kasapoğlu E, Kandil B, Gökyer A, Uzunoğlu S. Primary signet ring cell carcinoma of the breast: A case report and literature review. J Cancer Res Ther 2024; 20:1615-1617. [PMID: 39412931 DOI: 10.4103/jcrt.jcrt_1963_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/22/2022] [Indexed: 10/18/2024]
Abstract
ABSTRACT Primary signet ring cell carcinoma (SRCC) of the breast is a rare and aggressive type of breast cancer characterized by increased intracellular mucin production. It has a high risk of metastasis and poor prognosis compared to other breast cancer types. We report a 56-year-old woman with primary SRCC of the breast who first presented with retraction on her left breast. Radiological examination revealed a mass that causes the retraction. The patient underwent left modified radical mastectomy, and pathology results showed a 70% signet ring cell pattern. Chemotherapy consists of an adriamycin-cyclophosphamide regimen administered. in this case, we aim to review the literature on this topic and inform the physicians.
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Affiliation(s)
| | | | - Ali Gökyer
- Department of Medical Oncology, Kırklareli Education and Research Hospital, Turkey
| | - Sernaz Uzunoğlu
- Department of Medical Oncology, Trakya University Education and Research Hospital, Turkey
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Bendimya M, Kairouani M, El Magroud M, Bennani A, Al Jarroudi O, Brahmi SA, Afqir S. Unusual Metastasis of Gastric Signet Ring Cell Carcinoma to the Breast: A Case Report of a Young Moroccan Patient. Cureus 2024; 16:e56333. [PMID: 38629003 PMCID: PMC11021129 DOI: 10.7759/cureus.56333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Although gastric cancer is known to be an aggressive tumor that can spread throughout the body, breast metastases are uncommon. This entity is rarely reported in the literature, with an estimated incidence of 0.5 to 1.3%. We report a case of a rare association between a gastric subtype of signet ring cell carcinoma and metastasis to the breast. This uncommon situation is only documented through case reports. Most breast metastases have been detected after diagnosis of primary gastric cancer, during the first year. Several risk factors have been suggested to explain the aggressive behavior of these tumors, which correlates with very poor prognosis and short survival. We report the case of a 22-year-old female patient presenting with widespread metastatic gastric signet ring cell carcinoma with an unusual secondary site in the breast. The diagnosis was confirmed by immunohistochemistry (IHC) and radiology, and the patient was treated with palliative chemotherapy in accordance with the decision of the multidisciplinary tumor board.
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Affiliation(s)
- Mohammed Bendimya
- Medical Oncology, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Mohammed First University of Oujda, Oujda, MAR
| | - Mouna Kairouani
- Medical Oncology, Mohammed VI University Hospital, Mohammed First University of Oujda, Oujda, MAR
| | | | - Amal Bennani
- Anatomopathology, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
| | - Ouissam Al Jarroudi
- Medical Oncology, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Mohammed First University of Oujda, Oujda, MAR
| | - Sami Aziz Brahmi
- Medical Oncology, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Mohammed First University of Oujda, Oujda, MAR
| | - Said Afqir
- Medical Oncology, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Mohammed First University of Oujda, Oujda, MAR
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Rech MB, da-Cruz ER, Salgado K, Balbinot RA, Balbinot SS, Soldera J. Metastatic gastric cancer from breast carcinoma presenting with paraneoplastic rheumatic syndrome: A case report. World J Clin Cases 2023; 11:3282-3287. [PMID: 37274042 PMCID: PMC10237145 DOI: 10.12998/wjcc.v11.i14.3282] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/02/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Breast cancer is the most frequently diagnosed cancer worldwide. It is the leading cause of death by malignant disease in women. CASE SUMMARY A female patient, 73 years of age, sought care due to weakness, mild abdominal pain, arthralgia, and weight loss. She was taking anastrazole as maintenance therapy for localized breast cancer and had moderate anemia and elevated acute-phase markers. Upper digestive endoscopy showed isolated erosion in the gastric corpus. This lesion was compatible with signet-ring cell adenocarcinoma in anatomopathological study and was confirmed as metastasis of a breast carcinoma in immunohistochemistry, which was positive for estrogen antibody. Further imaging studies determined numerous proximal bone metastases. The patient was treated with prednisone for paraneoplastic syndrome, which improved the anemia and rheumatic disease, and with chemotherapy, which greatly improved the symptoms. She has been followed-up for 6 mo, and her anemia, arthralgias, and acute phase markers have normalized. CONCLUSION Systemic treatment strategies seem to be the best choice for gastric metastasis from breast cancer, resulting in disease control and relapse-free survival. Prospective studies with longer follow-up are needed to better understand the biological, pathological, and clinicopathological characteristics and outcomes of the endoscopic features associated with metastatic gastric cancer from breast carcinoma.
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Affiliation(s)
- Marília Bortoluz Rech
- School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
| | - Eduarda Renz da-Cruz
- School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
| | - Karina Salgado
- Department of Pathology, ICAP Pathology, Caxias do Sul 95020-002, Rio Grande do Sul, Brazil
| | - Raul Angelo Balbinot
- Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
| | - Silvana Sartori Balbinot
- Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
| | - Jonathan Soldera
- Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
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Zhang L, Wu L, Li J, Song S, Lu H, Fang C, Zhu K. Gastrointestinal metastatic signet ring cell breast cancer in young females: a case report. Gland Surg 2022; 11:943-952. [PMID: 35694084 PMCID: PMC9177283 DOI: 10.21037/gs-22-242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/13/2022] [Indexed: 05/11/2025]
Abstract
BACKGROUND Signet ring cell carcinoma (SRCC) is characterized by strong invasiveness and rapid progression. It occurs mostly in young and middle-aged patients, and early patients may have no clinical symptoms. Gastric SRCC with breast cancer metastasis is relatively rare. It often presents challenges for clinicians and pathologists and may lead to an absolutely different therapeutic strategy. CASE DESCRIPTION In this paper, we report on a 37-year-old woman who was admitted to the hospital with a left breast mass discovered 5 days earlier, the mass was occasionally painful, and there was no skin swelling, skin depression, or other abnormalities. The initial diagnosis considered her to have a left breast tumor. The patient was previously healthy with no family history of tumor. Considering the possibility of malignant lesions, she underwent resection of the left breast tumor and surrounding tissue. Postoperative pathological findings suggested SRCC (left breast mass). Although the patient had no history of gastrointestinal tumors, considering that SRCC can also appear in the gastrointestinal tract and other organs. We performed gastroscopy on the patient, showed an ulcerative mass in the greater curvature of the gastric body, with irregular nodular uplift of the surrounding mucosa. The excised breast lesions were analyzed by immunohistochemistry, and the pathological result showed SRCC (left breast tumor). Combined with the results of immunohistochemistry, it was consistent with gastrointestinal metastasis. Through our multi-faceted differential diagnosis, the final diagnosis of the patient was clear, which not only bought time for the patient's subsequent treatment, but also avoided misdiagnosis and blind treatment due to the particularity and rarity of the case. CONCLUSIONS Gastric cancer should be considered when breast tumors show SRCC without in situ lesion. Signet ring cell gastric cancer (occult) should be excluded even if the patient has no family history of gastric cancer. It is important to distinguish metastatic cancer from primary breast cancer to avoid misdiagnosis and blind treatment due to the particularity of the case, at which point an early recognition can be made and an optimal treatment plan can be chosen.
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Affiliation(s)
- Liang Zhang
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Breast and Thyroid Surgery, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Lingyuan Wu
- Reproductive Medicine Center, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Jiyu Li
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shasha Song
- Department of Pathology, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Huanyu Lu
- Department of Breast and Thyroid Surgery, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Chao Fang
- Department of Breast and Thyroid Surgery, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Kunbing Zhu
- Department of Breast and Thyroid Surgery, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
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Jin X, Tang H, Chen H, Chen G. Case Report: Metastatic Signet-Ring-Cell Carcinoma of the Bladder From Breast Invasive Lobular Carcinoma Detected by Computed Tomography. Front Oncol 2022; 12:835487. [PMID: 35252006 PMCID: PMC8888881 DOI: 10.3389/fonc.2022.835487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Secondary bladder tumors are relatively rare among all bladder tumors, while bladder metastases from breast cancer have been rarely reported. Furthermore, signet-ring differentiation may appear in the metastases from a breast invasive lobular carcinoma regardless of whether the primary breast tumor had signet-ring cells, which may cause diagnostic uncertainty. We report a case of a 55-year-old female patient with diffuse bladder thickening as the chief complaint and no specific clinical manifestations. While the cystoscopy showed multiple scattered red protuberances, the biopsy suggested signet-ring-cell carcinoma. The gastroscopy results suggested poorly differentiated adenocarcinoma with signet-ring cells. Considering the patient’s history of invasive lobular carcinoma of the breast, chronic myeloid leukemia, and metastatic endometrial carcinoma from the breast, we performed an immunohistochemical analysis and the results indicated that signet-ring-cell carcinomas of the stomach and bladder originated from the invasive lobular carcinoma of the breast. We performed positron emission tomography/computed tomography and the results showed that there were multiple bone metastases already present. This was the first English case report of invasive lobular carcinoma of the breast metastasizing to the uterus, stomach, bladder, and bones with multiple signet-ring-cell variations. This study shares our reasons for misdiagnosing and opinions on diagnosing and treating for this kind of cases.
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9
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Yang S, Li S. Development of prognostic predictive model with neutrophil-lymphocyte ratio (NLR) in patients with gastric signet ring carcinoma. Medicine (Baltimore) 2022; 101:e28043. [PMID: 35029873 PMCID: PMC8735796 DOI: 10.1097/md.0000000000028043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
The risk factors have not been well-defined for prognosis in gastric signet ring cell carcinoma (GSRC) patients. This study is designed to prognosticate survival in GSRC patients by establishing and verifying a predictive model with neutrophil-lymphocyte ratio (NLR).A total of 147 GSRC patients from Department of Surgical Oncology, Neimenggu Baogang Hospital, Inner Mongolia Medical University were retrospectively reviewed. A predictive model was established using Cox proportional hazards. The performance of the model was evaluated by ROC curves.In present study, we found that overall survival (OS) (P < .001, Fig. 1A) and tumor recurrence rate (P = .036, Fig. 1B) in the NLR ≤ 2.8 group were significantly better than those in the NLR > 2.8 group. These results showed that NLR ≤ 2.8 was significant prognostic factor related with both OS and tumor recurrence in patients with GSRC. After adjusting for competing risk factors, NLR ≤ 2.8 (hazard ratio [HR]: 2.625, 95% confidence interval [CI]: 1.505-5.3166, P = .003), tumor size (HR: 3.024, 95% CI: 1.521-4.186, P = .005), and tumor metastasis (HR: 3.303, 95% CI: 1.25-4.525, P = .012) remained independent predictors of tumor recurrence rate and OS. Our results showed that comparing with the model without NLR (area under ROC curve: 0.798), the model with NLR (area under ROC curve: 0.826) had significant better predictive power than the model without NLR, which further confirmed the value of NLR in predicting prognosis of patients with GSRC.In conclusion, a high NLR value independently predicts poor survival in patients with GSRC after surgery. The NLR may help oncologists evaluate outcomes of patients received surgical resection and chemotherapy in order to choose alternative therapies for patients with high NLR value.
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Moldovan TR, Căinap C, Fekete Z, Puşcaş E, Roman A, Buiga R, Olteanu D, Bota M, Căinap S, Bochiş O. Signet ring cell gastric carcinoma with breast and leptomeningeal metastases: a case report. Med Pharm Rep 2022; 95:88-91. [PMID: 35720245 PMCID: PMC9177095 DOI: 10.15386/mpr-1654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/28/2021] [Accepted: 08/30/2021] [Indexed: 01/19/2024] Open
Abstract
Gastric cancer is the 5th most common malignancy worldwide. Signet ring cell histology represents an aggressive subtype of gastric cancer, presenting at a younger age. Both breast and leptomeningeal metastases are rare locations of tumor dissemination, requiring correct and immediate diagnosis and treatment. We present a case of a 45-year old female with signet ring cell gastric carcinoma who developed both left breast and leptomeningeal metastases, requiring multiple chemotherapy lines. As far as we know, this is the first published case in literature following multiple lines of treatment for both breast and leptomeningeal metastases from signet ring cell gastric carcinoma.
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Affiliation(s)
| | - Călin Căinap
- "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania
- Oncology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Zsolt Fekete
- "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania
- Oncology-Radiotherapy Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Emil Puşcaş
- "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania
- Oncology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Roman
- "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania
- Medical Radiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rareş Buiga
- "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania
- Pathology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Olteanu
- "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania
| | - Mădălina Bota
- Mother and Child Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Căinap
- Mother and Child Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ovidiu Bochiş
- "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania
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11
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Principe DR, Raicu A, Cataneo J, Beverley HR, Hyser M. Perforating duodenal ulcer with umbilical herniation as a metastatic complication of primary signet ring cell carcinoma of the breast. J Surg Case Rep 2021; 2021:rjab034. [PMID: 33732425 PMCID: PMC7947957 DOI: 10.1093/jscr/rjab034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022] Open
Abstract
Primary signet ring cell carcinoma (SRCC) of the breast is extremely rare, and the associated patterns of metastatic dissemination poorly described. Here, we report the case of a 61-year-old woman presenting with acute abdominal pain. Esophagogastroduodenoscopy revealed a non-bleeding erosive gastropathy, which was biopsied and found significant for a poorly differentiated, GATA3-positive SRCC. The patient was lost to follow up until re-presenting 6 months later with a perforating duodenal ulcer and umbilical herniation. Biopsies of umbilical hernia sack contents were significant for an estrogen receptor (ER) positive SRCC, and breast examination identified a right breast mass significant for an ER positive lobular carcinoma with signet ring features, thereby affirming the diagnosis of metastatic SRCC of the breast. This case offers insight into an advanced form of a rare clinical entity, and suggests that staining for breast markers such as GATA3 should be considered for all biopsies significant for SRCC.
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Affiliation(s)
- Daniel R Principe
- Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, IL, USA
| | - Andreea Raicu
- University of Illinois, Metropolitan Group Hospitals General Surgery Residency, Advocate Illinois Masonic Hospital, Chicago, IL, USA
| | - Jose Cataneo
- Department of Surgery, University of Illinois College of Medicine, Chicago, IL, USA
| | - Holly R Beverley
- Library of the Health Sciences, University of Illinois College of Medicine, Chicago, IL, USA
| | - Matthew Hyser
- Department of Surgery, AMITA St. Francis Hospital, Evanston, IL, USA
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12
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Buerba-Vieregge HH, Fernández-Ferreira R, Soberanis-Piña PD, De la Peña-López IR, Navarro-García LM, Macari-Jorge A. Breast Metastasis of Gastric Signet Ring Cell Carcinoma: A Case Report and Literature Review. Case Rep Oncol 2021; 14:165-172. [PMID: 33776699 PMCID: PMC7983628 DOI: 10.1159/000510938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022] Open
Abstract
Breast metastasis from gastric signet ring cell carcinoma is extremely rare in clinical practice. The estimated incidence is 0.5-1.3%. There are few cases reported in the literature (approx. less than 60) of breast metastasis from gastric signet ring cell carcinoma, and due to the rare association between gastric cancer and its extension to the breast, it is difficult to establish the diagnosis. Clinical history, histological findings, and immunohistochemical markers are helpful in distinguishing primary breast cancer from breast metastasis of gastric cancer. The treatment for breast metastasis from gastric carcinoma remains controversial. The prognosis of breast metastasis from gastric carcinoma is generally poor. We report a case of breast metastasis of gastric signet ring cell carcinoma in a 38-year-old woman. She started chemotherapy with ramucirumab, paclitaxel, and irinotecan. Three months later, a combined 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography showed a complete response. This is the first reported case of breast metastasis from gastric signet ring cell carcinoma with a complete response.
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Affiliation(s)
- Héctor Hugo Buerba-Vieregge
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Ricardo Fernández-Ferreira
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Pamela Denisse Soberanis-Piña
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Ildefonso Roberto De la Peña-López
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Lilian Mónica Navarro-García
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Andrés Macari-Jorge
- Service of Anatomical Pathology, Medica Sur Clinic and Foundation, Mexico, Mexico
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13
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Nidhamalddin SJ, Hassan HA, Ali K, Ghareeb KAH, Gubari MIM. Breast cancer metastasis from Gastric Carcinoma in a young female. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/115858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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A Case Series of Breast Metastases from Different Extramammary Malignancies and Their Literature Review. Case Rep Radiol 2019; 2019:9454201. [PMID: 30729058 PMCID: PMC6341250 DOI: 10.1155/2019/9454201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/21/2018] [Accepted: 12/23/2018] [Indexed: 12/19/2022] Open
Abstract
Metastasis to the breast from all other primary sites is unusual. Twelve patients were diagnosed between 2007 and 2017 at National Cancer Institute, Mexico. Solitary or multiple masses, round or oval, and hypoechoic and solid lesions with posterior acoustic shadowing were patterns commonly reported in these patients; other arrangements include diffuse involvement of the breast simulating an inflammatory carcinoma. The development of a breast metastasis is revealed, in our experience, as a negative prognostic factor. Thus, the radiologist should know about the varied appearance of metastatic breast lesions and provide radiopathological correlations when available.
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15
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Ma Y, Liu W, Li J, Xu Y, Wang H. Gastric cancer with breast metastasis: Clinical features and prognostic factors. Oncol Lett 2018; 16:5565-5574. [PMID: 30344710 PMCID: PMC6176254 DOI: 10.3892/ol.2018.9383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 02/22/2018] [Indexed: 11/10/2022] Open
Abstract
Metastatic spread of gastric carcinoma to the breast is rare. In previous decades, reports on this subject were minimal and primarily limited to case reports. At present, little is known on the clinicopathological features and prognosis of this condition, and breast metastasis remains a challenging clinical problem. A total of 54 cases of breast metastasis from gastric cancer were collected from databases between January 1960 and December 2016. The present study included 3 cases of gastric cancer with breast metastasis from Renji hospital and 51 additional cases from previous studies. The clinicopathological features of patients, including epidemiology, symptoms, macroscopic presentation, pathological diagnosis, imaging, treatment and overall survival time, were analyzed. The median survival time was 8.6 months. All but one of the patients were female, and the median age at diagnosis of breast metastasis was 43 years old (age range, 22–72 years). A majority of patients presented with Borrmann class III disease, signet ring cell carcinoma, T4 tumor types, lymph node involvement, initial stage IV gastric cancer, primary lesions in the gastric antrum, left breast metastasis and palpable breast nodules. The median interval between the primary gastric carcinoma diagnosis and presentation of breast metastasis was 1.25 months (range, 0–72 months). The expression of the estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 and gross cystic disease fluid protein-15 was negative in the patients with breast metastases. In univariate analysis, age, gastric tumor size, gastric lymph node involvement and breast metastasis histology were significantly associated with overall survival (OS) time (P=0.001, 0.039, 0.034 and <0.001, respectively). Therapeutically, gastric surgery and chemotherapy were not associated with OS (P=0.959 and 0.290, respectively). In further multivariate analysis, the time between occurrence (P=0.017), age (P=0.009), histology (P=0.045) and breast metastasis localization (P=0.043) were independent indicators of OS time. Although breast metastasis from gastric cancer is rare, physicians should be vigilant when patients with a history of gastric cancer present with newly developed mammary symptoms and signs.
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Affiliation(s)
- Yue Ma
- Department of Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Wenwen Liu
- Department of Geratology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Junjian Li
- Department of Oncology, General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, P.R. China
| | - Yingchun Xu
- Department of Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Hongxia Wang
- Department of Oncology, General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, P.R. China
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16
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Wei LY, Kong M, Zhang Z, Zhang XC. Breast metastasis of gastric signet-ring cell carcinoma. J Zhejiang Univ Sci B 2018; 18:1026-1030. [PMID: 29119740 DOI: 10.1631/jzus.b1700159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Metastatic breast involvement from extra-mammary neoplasms is unusual with a low incidence of 0.5% to 1.2% in clinical practice, 2.7% in cytological series, and 1.7% to 6.6% in autopsy series of all breast malignancies. Nearly 500 cases have been reported in small series and case reports. Gastric carcinoma rarely metastasizes to the breast. There are only 38 cases reported in PubMed. In this study, we present a case report of a 49-year-old woman who was diagnosed with right breast metastasis from a gastric carcinoma and undertake a literature review to pay attention to the diagnosis, treatment, and the prognosis of the disease.
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Affiliation(s)
- Li-Yuan Wei
- Department of Plastic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Mei Kong
- Department of Pathology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Zhen Zhang
- Department of Oncology, Hangzhou Cancer Hospital, Hangzhou 310002, China
| | - Xiao-Chen Zhang
- Department of Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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17
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Kubo H, Shimizu T, Sekido H, Matsuda G, Takeda K, Watanabe A, Sakamoto R, Yamamoto Y, Toyoda J, Niino H. Isolated breast metastasis from gastric cancer in a male patient. Clin J Gastroenterol 2018; 11:138-144. [PMID: 29302921 DOI: 10.1007/s12328-017-0815-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 12/25/2017] [Indexed: 12/01/2022]
Abstract
A 72-year-old man underwent total gastrectomy for gastric cancer (por2, T3, N2, Stage IIIA). Eleven courses of postoperative chemotherapy with TS-1 (tegafur/gimeracil/oteracil) were administered. Five months after surgery, the serum carcinoembryonic antigen value was slightly elevated. However, computed tomography did not reveal any metastatic lesions in other organs. Two years after surgery, the patient felt a mass in the left mammary. A 2-cm tumor was palpable in the central portion of the breast. Ultrasonography revealed a hypoechoic tumor, which was Class 3 on aspiration biopsy cytological examination. No mass was detected on positron emission tomography-computed tomography. The mammary gland tumor increased in size to 3 cm, and a core needle biopsy procedure was performed. Histological examination findings revealed breast metastasis of gastric cancer. No other recurrence was found, and radical mastectomy was performed 2 years and 5 months after gastrectomy. Immunohistological analysis of the resected material confirmed breast metastasis of the gastric cancer. Two courses of TS-1 + cisplatin were administered, but this treatment was subsequently terminated because the patient experienced Grade 3 diarrhea and neutropenia. Three years and 1 month after the gastrectomy, the tumor recurred in the pelvic area. Chemotherapy and radiation therapy were performed, but the patient's overall condition became progressively worse, and he died 3 years and 9 months after gastrectomy.
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Affiliation(s)
- Hirokazu Kubo
- Department of Surgery, National Hospital Organization Yokohama Medical Center, Harajuku 3-60-2, Totsuka, Yokohama, Kanagawa, 245-8575, Japan.
| | - Tetsuya Shimizu
- Department of Surgery, National Hospital Organization Yokohama Medical Center, Harajuku 3-60-2, Totsuka, Yokohama, Kanagawa, 245-8575, Japan
| | - Hitoshi Sekido
- Department of Surgery, National Hospital Organization Yokohama Medical Center, Harajuku 3-60-2, Totsuka, Yokohama, Kanagawa, 245-8575, Japan
| | - Goro Matsuda
- Department of Surgery, National Hospital Organization Yokohama Medical Center, Harajuku 3-60-2, Totsuka, Yokohama, Kanagawa, 245-8575, Japan
| | - Kazuhisa Takeda
- Department of Surgery, National Hospital Organization Yokohama Medical Center, Harajuku 3-60-2, Totsuka, Yokohama, Kanagawa, 245-8575, Japan
| | - Akira Watanabe
- Department of Surgery, National Hospital Organization Yokohama Medical Center, Harajuku 3-60-2, Totsuka, Yokohama, Kanagawa, 245-8575, Japan
| | - Risa Sakamoto
- Department of Surgery, National Hospital Organization Yokohama Medical Center, Harajuku 3-60-2, Totsuka, Yokohama, Kanagawa, 245-8575, Japan
| | - Yuji Yamamoto
- Department of Surgery, National Hospital Organization Yokohama Medical Center, Harajuku 3-60-2, Totsuka, Yokohama, Kanagawa, 245-8575, Japan
| | - Junya Toyoda
- Department of Surgery, National Hospital Organization Yokohama Medical Center, Harajuku 3-60-2, Totsuka, Yokohama, Kanagawa, 245-8575, Japan
| | - Hitoshi Niino
- Department of Surgery, National Hospital Organization Yokohama Medical Center, Harajuku 3-60-2, Totsuka, Yokohama, Kanagawa, 245-8575, Japan
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18
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Yan H, Liu J, Ming X, Zhou X, Jin H, Li X, Zheng M. Metastatic gastric carcinoma to the breast: A case report and review of the Chinese literature. Mol Clin Oncol 2017; 7:221-224. [PMID: 28781789 DOI: 10.3892/mco.2017.1292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/09/2017] [Indexed: 11/05/2022] Open
Abstract
Breast metastasis is extremely unusual in gastric cancer patients worldwide. We herein report the case of a 39-year-old female Chinese patient presenting with symptoms of inflammation in the left breast. A biopsy did not reveal any evidence of malignancy. A modified radical mastectomy was performed and the postoperative pathological examination revealed infiltration by signet ring cell gastric carcinoma. A review of the Chinese literature was performed, and a total of 16 patients with breast metastasis from gastric carcinoma have been reported from 1990 onwards. This condition is associated with a poor prognosis, with a survival time of 1 month to 4 years. More studies are required to determine the optimal treatment.
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Affiliation(s)
- Huanhuan Yan
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Jun Liu
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Xu Ming
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Xiaoqian Zhou
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Hui Jin
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Xiang Li
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Miao Zheng
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
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19
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Zullo A, Balsamo G, Lorenzetti R, Romiti A, De Francesco V, Hassan C, Manta R. Gastric metastases from gynaecologic tumors: case reports and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:483. [PMID: 28149845 DOI: 10.21037/atm.2016.12.51] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The stomach is an infrequent localization of tumor metastases, and metastases originating from primary gynaecological cancers are particularly rare. We described the case of three females with ovarian, uterine, and breast metastases in the stomach, and we performed a systematic review of the literature of cases diagnosed at endoscopy. Overall, data of 18 patients with gastric metastases originating from the ovary, 11 from the uterus, and 159 from breast cancer were analyzed. Therefore, gastric metastasis mainly occurs from breast cancer, whilst both ovarian and uterine metastases are distinctly less frequent, but not impossible.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | | | | | - Adriana Romiti
- Oncology Unit, Sant'Andrea University Hospital, Rome, Italy
| | | | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Raffaele Manta
- Gastroenterology Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy
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20
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Poorer Prognosis of Primary Signet-Ring Cell Carcinoma of the Breast Compared with Mucinous Carcinoma. PLoS One 2016; 11:e0162088. [PMID: 27583684 PMCID: PMC5008818 DOI: 10.1371/journal.pone.0162088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/17/2016] [Indexed: 11/20/2022] Open
Abstract
Primary signet-ring cell carcinoma (PSRCC) of the breast is a rare entity and classified under mucin producing tumors in the WHO classification. However, little is known about the clinicopathological characteristics and clinical outcomes of PSRCC as opposed to mucinous carcinoma. Eleven patients with PSRCC in our center from 1995 to 2010 were evaluated in this study, as compared to 50 cases of mucinous breast cancer (MBC) during the same period. The clinicopathologic features of PSRCC compared to MBC were assessed. Furthermore, overall survival (OS) and disease-free survival (DFS) were calculated at 5 years of follow up. Patients with PSRCC showed more frequent lymphatic metastasis, higher Ki67 labeling index and more advanced stage disease than that of MBC (P = 0.018, p = 0.023, P = 0.000, respectively), although there was no difference in age, tumor size, and ER, PR expression between PSRCC and MBC. In addition, PSRCC was associated with simultaneous vimentin upregulation and E-cadherin downregulation. The 5-year OS of PSRCC (54.5%) was significantly lower than that of MBC (88%) (P = 0.004). Similarly, the DFS of PSRCC was poorer than that of MBC significantly (5-year DFS: 27.3% vs. 80%, P = 0.000).
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