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Han Y, Yang W, Ma Q, Cai Z, Yang Y, Gou J, Yuan T, Zhang M, Zhang B. Case Report: Systemic treatment for breast and vulvar metastases from resected rectal signet ring cell carcinoma. Front Oncol 2023; 13:1213888. [PMID: 37483522 PMCID: PMC10359816 DOI: 10.3389/fonc.2023.1213888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Background Breast and vulvar metastases from rectal signet ring cell carcinoma (SRCC) represent a rare and obscure clinical entity associated with poor survival. Managing patients with metastatic rectal SRCC is extremely challenging due to the absence of high-quality evidence. Case presentation A 26-year-old woman presented with progressively worsening anal pain, constipation, and hematochezia for approximately two years. Following the diagnosis of locally advanced rectal cancer (cT3N0-1M0), she received neoadjuvant chemotherapy with modified FOLFOX6 regimen and underwent laparoscopic abdominoperineal resection. Metastases to the breast and vulva developed during postoperative chemotherapy. Genetic testing revealed RAS/BRAF wild-type and microsatellite instability (MSI)-low status. Though sequential administration of irinotecan plus tegafur and tegafur plus raltitrexed-based chemotherapy in combination with bevacizumab, the disease progressed rapidly. Sadly, the patient passed away 15 months after initial diagnosis due to rapidly progressive disease. Conclusion Rectal SRCC is associated with younger on-set, aggressive behaviors, and worse survival outcomes. Due to poor cohesiveness, SRCC tends to develop metastases. A patient's medical history and immunohistochemical staining (such as CK20, CK7, and CDX-2) can aid in identifying the tumor origin of breast and vulvar metastases. Mutations and signaling pathways predominant in the tumorigenesis of SRCC remains unveiled. There is poor effect of conventional chemotherapies, targeted and immunotherapies for colorectal adenocarcinoma on SRCC, so novel therapies are needed to treat this patient population.
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Affiliation(s)
- Yihui Han
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenming Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Ma
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Shangjin Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Yang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Shangjin Hospital, Sichuan University, Chengdu, China
- Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Junhe Gou
- Department of Pathology, West China Shangjin Hospital, Sichuan University, Chengdu, China
| | - Tao Yuan
- Department of Anesthesiology, West China Shangjin Hospital, Sichuan University, Chengdu, China
| | - Mingming Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Shangjin Hospital, Sichuan University, Chengdu, China
- Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Xu J, Liu C, Yu C, Yu T, Fan F, Zhang X, Huang C, Chen W, Sun Z, Zhou M. Breast mass as the first sign of metastasis from rectal carcinoma: a case report and review of the literature. Front Oncol 2023; 13:1211645. [PMID: 37434982 PMCID: PMC10332164 DOI: 10.3389/fonc.2023.1211645] [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] [Received: 04/25/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
We present a case report of a 41-year-old woman who developed a left breast mass 18 months after undergoing Dixon rectal cancer surgery. The purpose of this case report is to highlight the possibility of breast metastases in patients with colorectal cancer and emphasize the importance of careful evaluation and follow-up as well as timely and accurate diagnosis and management of the metastatic disease. During the physical examination in 2021, we noted that the lower border of the mass was 9 cm from the anal verge and that it occupied approximately one-third of the intestinal lumen. A pathological biopsy revealed the mass in the patient's intestinal lumen was a rectal adenocarcinoma. The patient underwent Dixon surgery for rectal cancer and received subsequent chemotherapy. The patient had no prior history of breast-related medical conditions or a family history of breast cancer. During the current physical examination, we discovered multiple lymphadenopathies in the patient's left neck, bilateral axillae, and left inguinal region, but none elsewhere. We observed a large erythema of about 15x10 cm on the patient's left breast, with scattered hard nodes of varying sizes. Palpation of the area beyond the upper left breast revealed a mass measuring 3x3 cm. We conducted further examinations of the patient, which revealed the breast mass and lymphadenopathy on imaging. However, we did not find any other imaging that had significant diagnostic value. Based on the patient's conventional pathology and immunohistochemical findings, combined with the patient's past medical history, we strongly suspected that the patient's breast mass was of rectal origin. This was confirmed by the abdominal CT performed afterward. The patient was treated with a chemotherapy regimen consisting of irinotecan 260 mg, fluorouracil 2.25 g, and cetuximab 700 mg IV drip, which resulted in a favorable clinical response. This case illustrates that colorectal cancer can metastasize to unusual sites and underscores the importance of thorough evaluation and follow-up, particularly when symptoms are atypical. It also highlights the importance of timely and accurate diagnosis and management of metastatic disease to improve the patient's prognosis.
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Affiliation(s)
- Jiawei Xu
- Department of Breast Surgery, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Pathology, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chao Liu
- Department of Breast Surgery, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chengdong Yu
- Department of Breast Surgery, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tenghua Yu
- Department of Breast Surgery, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Fan Fan
- Department of Breast Surgery, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaofang Zhang
- Department of Pathology, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chuansheng Huang
- Department of Pathology, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wen Chen
- Department of Breast Surgery, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhengkui Sun
- Department of Breast Surgery, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Meng Zhou
- Department of Breast Surgery, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Affiliated Cancer Hospital of Nanchang University, Nanchang, Jiangxi, China
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Dai Y, Jin Y, Lan A, Ding N, Jiang L, Liu S. Breast Metastasis From Rectal Signet-Ring Cell Carcinoma: A Case Report and Review of Literature. Front Oncol 2022; 12:873354. [PMID: 35444939 PMCID: PMC9013961 DOI: 10.3389/fonc.2022.873354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Metastatic rectal cancer (mRC) of the breast is an extremely rare clinical situation. There are few reported cases in domestic or foreign literature. The clinicopathologic characteristics along with the diagnostic and therapeutic strategies of such cases remain relatively unclear. Here, we would like to provide our comprehensive insights into this rare entity. METHODS We present a case that till now is the first reported breast metastasis from rectal cancer pathologically diagnosed as a signet-ring cell carcinoma, and we review the current literature on this rare event. The detailed clinical data, histopathology, management, and follow-up aspects were gathered for analysis. RESULTS A total of 15 cases were collected including the current case. Breast metastases from rectal cancer present at an average age of 47.7 years (range, 28 to 69 years) and appear with an average interval of 28.4 months (range, 5 months to 18 years) following primary tumor diagnoses. Of the 15 cases, 8 and 5 are pathologically diagnosed as adenocarcinomas and mucinous adenocarcinomas, respectively. Most cases (11/15) are accompanied by extramammary metastases. About half of the breast metastases (7/15) were to the left. In all cases, the main complaints were palpable mass. The average maximum diameter of the metastatic mass is 2.7 cm (range, 1-11 cm). The majority (8/12) of cases with accessible therapy information exclude the option of local surgery. CONCLUSION Previous cancer history and accurate immunohistochemistry data play critical roles to distinguish mammary metastasis from a primary neoplasm of the breast. Mastectomy and molecular-targeted drugs should be considered with priority if systemic condition supports them.
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Affiliation(s)
- Yuran Dai
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yudi Jin
- Department of Pathology, Chongqing University Cancer Hospital, Chongqing, China
| | - Ailin Lan
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nan Ding
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linshan Jiang
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shengchun Liu
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Shengchun Liu,
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Cheng X, Zhao T, Jiang JN, Liu Y, Li H, Wang RY. Rare case of a male breast tumour secondary to poorly differentiated rectal adenocarcinoma. Transl Cancer Res 2020; 9:7676-7681. [PMID: 35117368 PMCID: PMC8799063 DOI: 10.21037/tcr-20-1936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/21/2020] [Indexed: 11/07/2022]
Abstract
Rectal cancer metastasis to the breast is rare. A case history is presented of a 57-year-old man with breast metastases from rectal carcinoma. However, this patient did not have metastasis in common metastatic sites, such as the liver, lung, and other organs. The patient had undergone chemotherapy for advanced rectal carcinoma 6 months earlier and presented with a mammary mass. An ultrasound-directed core needle biopsy of the breast mass was performed. Cytology indicated an adenocarcinoma with poor to moderate differentiation in the breast mass Immunohistochemistry (IHC) showed cytokeratin (CK) expression with a pattern that is characteristic of colorectal tumours: CK7(−), CK20(+), CDX2(−), Villin(+) TOPOII(−), and a Ki-67 index of 30%. The 3 main breast tumour markers were negative. Based on these histopathological and immunohistochemical findings, the patient was diagnosed with breast metastases from rectal carcinoma. Distant metastasis should be taken into account when a patient has a medical history of rectal adenocarcinoma, even when a rare metastasis site is involved. We should be vigilant when patients have some features that are favorable for metastasis. Histopathological characteristics and immunohistochemical tests are helpful for diagnosis. Regardless of surgical treatment after neoadjuvant chemotherapy, standard chemotherapy regimens for intestinal tumors, and EGFR molecular-targeted drugs, there is no obvious effect and the prognosis is poor. The treatment method needs further study.
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Affiliation(s)
- Xia Cheng
- Graduate School, Dalian Medical University, Dalian, China
| | - Tong Zhao
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jia-Ning Jiang
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ying Liu
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Heming Li
- The Key Laboratory of Biomarker High Throughput Screening and Target Translation of Breast and Gastrointestinal Tumor, Dalian, China
| | - Ruo-Yu Wang
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Balhareth A, AlQatari AA, Aldulaijan F, Joudeh A. Colonic mucinous adenocarcinoma with secondary in the breast: A case report and literature review. Int J Surg Case Rep 2020; 76:364-371. [PMID: 33074138 PMCID: PMC7569264 DOI: 10.1016/j.ijscr.2020.09.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Secondary breast metastasis from the colonic origin is a rare phenomenon in the literature, and an estimation of an increase in the incidence has been reported in the literature to reach approximately 7%. PRESENTATION OF CASE We report a case of a 56-year-old male with constipation who underwent extended right hemicolectomy after confirmation of adenocarcinoma of the right colon. The patient was diagnosed with multiple metastases over 5 years and endured numerous resections of the costal margins, ribs, diaphragm, liver wedges, abdominal wall, and the small bowel. Eventually, the patient's right breast mass measured about 2.1 cm on ultrasonography and revealed metastatic adenocarcinoma of the same colonic origin. The patient started on palliative chemotherapy and was deceased after 11 months. DISCUSSION Comparing this case to the 56 similar cases, we found our case with an almost average time to metastasize but unfortunately with aggressive metastatic behavior to various organs. Nevertheless, the triple assessment of the breast by physical examination, radiological, and pathological studies assisted in diagnosis and early establishment of the treatment. Currently, there is no definitive guideline for the management of secondary breast metastasis from the colonic origin. We estimated the average survival rate as 6.1 months, and it was reported to reach an average of 8-10 months in the literature. CONCLUSION During the surveillance program of colorectal cancer, a full-body examination is warranted. Secondary breast cancer metastasis from colorectal origin behaves aggressively and a multidisciplinary approach is essential for the establishment of personalized treatment.
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Affiliation(s)
- Ameera Balhareth
- Division of Colorectal Surgery, Department of Surgery, King Fahd Specialist Hospital, Dammam, Saudi Arabia.
| | - Abdullah A AlQatari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fozan Aldulaijan
- Division of Breast Surgery, Department of Surgery, King Fahd Specialist Hospital, Dammam, Saudi Arabia
| | - Amani Joudeh
- Division of Surgical Histopathology, Department of Histopathology, King Fahd Specialist Hospital, Dammam, Saudi Arabia
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Hsieh TC, Hsu CW. Breast metastasis from colorectal cancer treated by multimodal therapy: Case report and literature review. Medicine (Baltimore) 2019; 98:e18016. [PMID: 31860952 PMCID: PMC6940129 DOI: 10.1097/md.0000000000018016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Breast metastases from primary colorectal carcinoma are extremely rare, with only 45 cases being reported previously. Since the most common malignancy in the breast and axilla is primary breast cancer regardless of cancer history, non-hematologic metastases may be misdiagnosed initially. Nevertheless, differentiating breast metastases from primary breast cancer is crucial because of their differences in prognosis and management. PATIENT CONCERNS We present a case of a 44-year-old Asian woman who noticed a new right breast lump after undergoing surgery and chemotherapy for her primary sigmoid colon cancer. DIAGNOSIS Image and immunohistochemistry findings were consistent with breast metastasis from primary colorectal adenocarcinoma. INTERVENTIONS The patient underwent breast tumor excision and reinitiated chemotherapy. OUTCOMES The patient's disease progressed despite the interventions. She passed away 7 months after the detection of breast metastasis. CONCLUSION When a new breast lesion is detected in patients with colorectal cancer history, the physician should consider the possibility of breast metastasis due to the poor prognosis. If a biopsy is necessary, cancer history should be provided to the clinicians to prevent incorrect pathological interpretation. In establishing the diagnosis, certain immunohistochemical markers have been shown to be sensitive and specific in previously reported cases. The combination of tumor excision and chemotherapy was the most common strategy in managing this condition with inconsistent clinical outcomes.
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Affiliation(s)
- Tien-Chan Hsieh
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- Department of Internal Medicine, Danbury Hospital, Danbury, CT
| | - Chao-Wen Hsu
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei City, Taiwan
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Ahmad SS, Khalilullah K, McGowan K, Dillon K. Unexpected destination! Rectal carcinoma metastasis to breast. J Surg Case Rep 2019; 2019:rjz036. [PMID: 30891171 PMCID: PMC6416825 DOI: 10.1093/jscr/rjz036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/03/2019] [Indexed: 11/14/2022] Open
Abstract
Rectal cancer metastasis to the breast is rare with around 19 cases reported in literature. It signifies diffuse disseminated disease or highly aggressive tumour, such that surgical intervention other than palliation has a limited role. We report a case of a 43-year-old with the above presentation. As the management differs and because of its rarity the importance of the diagnosis between primary and the metastatic breast cancer is imperative.
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Affiliation(s)
- Syed Sohail Ahmad
- Department of Surgery, Letterkenny University Hospital Letterkenny, County Donegal, Ireland
| | - Kaleem Khalilullah
- Department of Surgery, Letterkenny University Hospital Letterkenny, County Donegal, Ireland
| | - Katherine McGowan
- Department of Surgery, Letterkenny University Hospital Letterkenny, County Donegal, Ireland
| | - Katrina Dillon
- Department of Surgery, Letterkenny University Hospital Letterkenny, County Donegal, Ireland
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