Metastasis to the pancreas and stomach from a breast cancer primary: a case report

Metastasis to the stomach: a systematic review

Background: This study reviews the literature on gastric metastases (GM) in terms of diagnosis, treatment, and outcomes. The goal of this study was to provide clinicians with a reliable and beneficial source to understand gastric metastases arising from various primary tumors and to present the growing literature in an easily accessible form. Methods: Articles published in English language from implementation of MEDLINE and Cochrane databases until May 2022 were considered for the systematic review. Articles other than English language, letters to the editor, posters, and clinical images were excluded. Hematogenous and lymphogenic metastases were included whereas direct tumoral invasion and seeding were excluded. Articles and abstracts were analyzed and last selection was done after cross-referencing and by use of defined eligibility criteria. Results: In total 1,521 publications were identified and 170 articles were finally included totaling 186 patients with GM. The median age of patients was 62 years. Gynecologic cancer was the most common cancer type causing GM (67 patients), followed by lung cancer (33 patients), renal cancer (20 patients), and melanoma (19 patients). One of the main treatment methods performed for metastasis was resection surgery (n=62), sometimes combined with chemotherapy (ChT) or immunotherapy. ChT was the other most used treatment method (n=78). Also, immunotherapy was amongst the most preferred treatment options after surgery and ChT (n=10). Conclusions: As 172 case reports were screened in the systematic review from different journals, heterogeneity was inevitable. Some articles missed important information such as complete follow-up or clinical information. Moreover, since all of the included articles were case reports quality assessment could not be performed. Among 172 case reports reviewed, resection surgery was performed the most and was sometimes combined with ChT and immunotherapy. Further research about what type of treatment has the best outcomes for patients with gastric metastases is needed.

Fine needle aspiration of pancreatic lesions focusing on secondary tumors with emphasis of metastatic breast cancer: A clinicopathological study with follow-up

BACKGROUND

The data on metastatic tumors to the pancreas diagnosed by fine needle aspiration (FNA) biopsy is limited. We report our experience of FNA of primary and secondary pancreatic tumors emphasizing metastatic breast cancer in the pancreas.

METHOD

Total 274 cases of pancreatic FNA in 10 years were retrospectively reviewed. Literature review of metastatic breast cancers to the pancreas was performed.

RESULTS

Out of the 274 cases, 7 (7/274, 2.6%) cases were non-diagnostic, 46 (46/274, 16.8%) cases were negative for malignancy, and 40 (40/274, 14.6%) cases were under the category of atypical cells. There were 133 (133/274, 48.5%) cases diagnosed as positive for malignancy, 20 (20/274, 7.3%) suspicious for malignancy, and 28 (28/274, 10.2%) cases in the category of neoplastic: other. The most common neoplasm diagnosed was ductal adenocarcinoma (114/274, 41.6%; 114/133, 85.7% in positive for malignancy category). Ten cases (10/274, 3.7%) were diagnosed as metastatic neoplasms to the pancreas, including four breast infiltrating ductal carcinomas (IDC), one endocervical adenocarcinoma, one anal/rectal squamous cell carcinoma, one renal cell carcinoma, one hepatocellular carcinoma, one seminoma and one lung adenocarcinoma. We summarized the biomarkers of the four metastatic breast cancers and conducted literature review on biomarkers of metastatic breast cancers to the pancreas.

CONCLUSIONS

Upon analyzing FNAs of primary and secondary tumors in the pancreas, we have found breast carcinoma is the most common secondary pancreatic neoplasm in our patient population. Triple negative breast ductal carcinoma is the most common tumor among the metastasis of breast carcinomas to the pancreas. To the best of our knowledge, this study is the first report with a literature review focusing on biomarkers of metastatic breast cancer to the pancreas.

Metastasis to the pancreas: a rare site for secondary malignancy of breast cancer (a case report)

Breast cancer is the most frequent invasive cancer in women and the second cause of death by cancer in women after lung cancer. It causes metastases especially to bones, liver and lungs. Pancreatic metastases from a primary breast neoplasm are rare and unusual, occurring in less than 3% of the cases. There have been only 28 cases described in the literature. This paper adds one more case to the published literature. We present a case of pancreatic metastasis of the breast in a 64-year-old female and a discussion based on a review of the literature.

A rare case report of recurrent metastatic breast cancer mimicking primary pancreatic cancer

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Secondary pancreatic tumors are rare, of which a breast primary is extremely uncommon.

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Invasive lobular carcinoma is the commonest breast cancer histological subtype metastasizing to the pancreas.

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Imaging characteristics can usually adequately differentiate secondary from primary pancreatic tumors.

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Pancreatic metastasectomy offers reasonably good long-term survival rates and can even be curative in selected cases.

Introduction

Secondary pancreatic tumors are rare, of which a breast cancer primary is extremely uncommon. To our knowledge, we present the 14th case reported worldwide and first from Singapore of lobular breast cancer metastasizing to the pancreas.

Presentation of case

A 53-year-old woman presented with painless obstructive jaundice, weight loss over 1.5 months and a 2 cm right breast mass. She had left breast Invasive Lobular Carcinoma (ILC) treated 5 years prior with wide local excision, adjuvant radiotherapy and hormonal therapy. She had elevated bilirubin, liver enzymes and Cancer Antigen (CA) 19–9. Imaging found 3 right breast nodules, left axillary lymphadenopathy, biliary dilatation with an ampullary mass, and bone metastases. Breast nodule biopsies confirmed ILC but ampullary mass cytopathology was inconclusive. Frozen section of the mass during exploratory laparotomy showed metastatic ILC; a triple bypass surgery was done and chemo-endocrine therapy commenced.

Discussion

ILC is the commonest type of breast carcinoma in cases with pancreatic metastases, usually recurring after long disease-free intervals, and widely metastatic at presentation. Imaging characteristics help differentiate secondary from primary pancreatic tumors. Radiological features and history of an extra-pancreatic cancer suffice in suspecting pancreatic metastases. Despite limited surgical experience, it is well accepted that pancreatic metastasectomy offers reasonably good long-term survival rates, quality of life and can even be curative in highly selected cases.

Conclusion

This case is an interesting case because it highlights the diagnostic dilemma involved in the rare entity of breast cancer metastatic to the pancreas, and summarizes its diagnosis and management.

EUS-FNA Diagnosis with Core Biopsy of Pancreatic Metastases from Primary Breast Cancer

Background

The pancreas as a site of metastasis of other primary tumors is a rare event. Pancreatic metastases may occur years after the start of treatment of a neoplasm of another organ or may be the initial manifestation of an unidentified primary tumor. The most commonly reported primary sites for pancreatic metastases are the kidneys, lungs, breast, bowel, and skin (melanoma). Case Summary. The authors report a case of pancreatic metastasis derived from a primary breast cancer that underwent endoscopic ultrasound fine-needle aspiration (EUS-FNA) core biopsy to obtain tissue, which made it possible to perform an immunohistochemical study.

Conclusion

We emphasize the importance of outpatient follow-up after the treatment of a neoplasia and the completion of control exams. In addition, we should always be aware of the finding of a secondary lesion in patients who have already been diagnosed with cancer, even if it is located in unusual organs, as in this case, where two metastases of a breast carcinoma to the pancreas were detected.

When a metastatic breast cancer is mimicking a pancreatic cancer: case report and review of the literature

We report the case of a 51 year-old female who complained of jaundice and weight loss. At the time of presentation, she had been in remission from a stage 2a ductal breast carcinoma for 58 months. The clinical presentation was suggestive of a primary pancreas cancer with liver metastases and retroperitoneal lymph nodes. We performed liver and pancreas biopsies that demonstrate a relapse of her old breast carcinoma with positive hormone receptors and HER2 positive. Conservative treatment by chemotherapy was given with Paclitaxel - Trastuzumab and Pertuzumab. Pancreatic metastases are uncommon. Furthermore, pancreatic metastases from breast cancer are very rare. We performed a review of the literature and found 48 cases of pancreatic metastases from breast cancer. We would like to highlight by this case that when a pancreatic lesion appears, in patients with a past history of cancer, physicians must not forget the possibility of metastases from primary tumor even if the initial stage, of the tumor, is low. However the diagnosis is not always easy. If liver and pancreatic lesions occur simultaneously, the clinical presentation can mimic metastatic primary pancreatic cancer. Therefore performing biopsy is highly recommended for making the correct diagnosis and also for the staging of the disease and the choice of the best treatment according to immunohistochemical analysis.

Drug Resistance-Related Competing Interactions of lncRNA and mRNA across 19 Cancer Types

Drug resistance is a common cause of treatment failure in cancer therapy, and molecular mechanisms need further exploration. Competing endogenous RNAs (ceRNAs) can influence drug response by participating in various biological processes, including regulation of cell cycle, signal transduction, and so on. In this study, we systematically explored resistance from the perspective of ceRNA modules. First, we constructed a general ceRNA network, involving 83 long non-coding RNAs (lncRNAs) and 379 mRNAs. Next, we identified the drug resistance-related modules for 138 drugs and 19 cancer types, totaling 758 drug-cancer conditions. Function analysis showed that resistance-related biological processes were enriched in these modules, such as regulation of cell proliferation, DNA damage repair, and so on. Pan-drug and pan-cancer analyses revealed some common and specific modules across multiple drugs or cancers. In addition, we also found that drug pairs with common modules have similar structure, indicating high risk for multidrug resistance (MDR). Finally, we speculated that ceRNA pair GAS5-RPL8 could regulate drug resistance because low expression of GAS5 would enhance microRNA (miRNA)-mediated inhibition of RPL8. In total, we investigated the drug resistance by using ceRNA modules and proposed that ceRNA modules may be new markers for drug resistance that indicated a possible novel mechanism.