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Ayadi S, Monastiri S, Safta AB, Hammami M, Samaali I, Kammoun M, Blel A, Aloui R, Zaimi Y, Mouelhi L. Gastric metastasis and peritoneal carcinosis revealing primary breast cancer: an unusual presentation. Future Sci OA 2024; 10:FSO970. [PMID: 38884375 PMCID: PMC11185184 DOI: 10.2144/fsoa-2023-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/29/2024] [Indexed: 06/18/2024] Open
Abstract
Breast cancer is the most frequent cancer among women. Gastrointestinal tract metastases are uncommon and might be misidentified as primary carcinoma.A noteworthy case-study involved 53-year-old-woman complaining from epigastric pain, ascites and overall health decline. Initial investigations were inconclusive, prompting laparoscopic peritoneal biopsies which revealed independent cell proliferation. Subsequently, a second look upper digestive endoscopy showed multiple gastric ulcerations suggestive of gastric carcinoma. Histologic examination confirmed independent cell proliferation with estrogen receptors expression, a characteristic feature of breast carcinoma. Further investigations led to bilateral invasive lobular breast carcinoma diagnosis. Epirubicin cycophosphamide was prescribed after progression under letrozole ribocilib therapy.This case aims to raise awareness among clinicians about the importance of ruling out breast cancer in patients with peritoneal carcinosis and paying attention to digestive symptoms in breast cancer patients with careful gastric endoscopic examination to avoid misdiagnosis.
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Affiliation(s)
- Shema Ayadi
- Gastroenterology Department, Charles Nicolle university hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Souhir Monastiri
- Gastroenterology Department, Charles Nicolle university hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Amine Ben Safta
- Surgery B Department, Charles Nicolle university hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mehdi Hammami
- Surgery B Department, Charles Nicolle university hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Imen Samaali
- Surgery B Department, Charles Nicolle university hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mehdi Kammoun
- Surgery B Department, Charles Nicolle university hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ahlem Blel
- Pathology Department, Charles Nicolle university hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Raoudha Aloui
- Pathology Department, Charles Nicolle university hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yosra Zaimi
- Gastroenterology Department, Charles Nicolle university hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Leila Mouelhi
- Gastroenterology Department, Charles Nicolle university hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Lin J, Lin ZQ, Zheng SC, Chen Y. Immune checkpoint inhibitor-associated gastritis: Patterns and management. World J Gastroenterol 2024; 30:1941-1948. [PMID: 38681126 PMCID: PMC11045486 DOI: 10.3748/wjg.v30.i14.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/23/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) are widely used due to their effectiveness in treating various tumors. Immune-related adverse events (irAEs) are defined as adverse effects resulting from ICI treatment. Gastrointestinal irAEs are a common type of irAEs characterized by intestinal side effects, such as diarrhea and colitis, which may lead to the cessation of ICIs. Although irAE gastritis is rarely reported, it may lead to serious complications such as gastrorrhagia. Furthermore, irAE gastritis is often difficult to identify early due to its diverse symptoms. Although steroid hormones and immunosuppressants are commonly used to reverse irAEs, the best regimen and dosage for irAE gastritis remains uncertain. In addition, the risk of recurrence of irAE gastritis after the reuse of ICIs should be considered. In this editorial, strategies such as early identification, pathological diagnosis, management interventions, and immunotherapy rechallenge are discussed to enable clinicians to better manage irAE gastritis and improve the prognosis of these patients.
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Affiliation(s)
- Jing Lin
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350000, Fujian Province, China
| | - Zhong-Qiao Lin
- Phase I Clinical Trial Ward, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350000, Fujian Province, China
| | - Shi-Cheng Zheng
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350000, Fujian Province, China
| | - Yu Chen
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350000, Fujian Province, China
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Hu JL, Guo ZJ, Wang C, Yan J, Yang H. Ovarian serous carcinoma with stomach metastasis: a rare case report and literature review. J Int Med Res 2024; 52:3000605241245000. [PMID: 38635893 PMCID: PMC11032054 DOI: 10.1177/03000605241245000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
Ovarian cancer is a common tumor among women. It is often asymptomatic in the early stages, with most cases already at stage III to IVE at the time of diagnosis. Direct spread and lymphatic metastasis are the primary modes of metastasis, whereas hematogenous spread is rare. An initial diagnosis of ovarian cancer that has metastasized to the stomach is also uncommon. Therefore, clear treatment methods and prognostic data for such metastasis are lacking. In our hospital, we encountered a patient with an initial imaging diagnosis of a gastric tumor and a history of an ovarian tumor with endoscopic abdominal metastasis. Based on the characteristics of the case, the two tumors were considered to be the same. After chemotherapy, a partial response was observed in the stomach and pelvic lesions, suggesting the effectiveness of the treatment. Through three treatments of recurrence, gastroscopy confirmed the stomach to be a metastatic site. Therefore, determining the primary source of advanced tumors is crucial in guiding treatment decisions. Clinicians must approach this comprehensively, relying on thorough evaluation and personal experience.
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Affiliation(s)
- Jia-Li Hu
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Zhao-Jiao Guo
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Chun Wang
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jun Yan
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Hao Yang
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
- Shanghai Key Laboratory of Molecular Imaging, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
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Drozgyik A, Molnár FT, Tokodi Z, Bodoky G, Kollár D, Oláh A. Emlőrák hasüregi áttétei - Egy szokatlan entitás klinikopatológiai jellemzői. Magy Seb 2022; 75:265-269. [PMID: 36515915 DOI: 10.1556/1046.2022.40003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/29/2022] [Indexed: 06/17/2023]
Abstract
CASE REPORT A sixty-five-year-old female patient underwent surgery for severe gastrointestinal symptoms, following an alarming CT image. Laparotomy revealed irresectable gastric cancer and peritoneal carcinosis. Palliative gastro-jejunostomy and ileo-descendostomy were performed. The endoscopic diagnosis - linitis plastica - and the intraoperative macroscopic appearance matched and agreed on the histologically presumed shigillocellular carcinoma. Three years following the initial abdominal symptoms, histological samples taken from newly detected cutaneous metastases which developed during oncological palliative treatment verified occult lobular breast carcinoma. Histological revision of the sample taken from abdominal exploration confirmed the latter diagnosis. The hormone receptor positive, human epidermal growth factor receptor-2 negative malignancy showed very good regression for the palliative hormone treatment. DISCUSSION About ten percent of breast cancer cases are lobular carcinomas, which are more often multicentric, bilateral, occult and have a propensity to metastasize to serous membranes, abdominal and pelvic viscera. Due to the increasing survival of breast cancer patients, the number of abdominal metastases of breast cancer is expected to increase. Histological confirmation is indispensable even in case of advanced abdominal malignancies, especially in the case of an unusual medical history. The currently rare case demonstrates the need for multidisciplinary cooperation in all diagnostic and therapeutic fields of breast cancer.
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Affiliation(s)
- András Drozgyik
- 1Petz Aladár Egyetemi Oktató Kórház, Sebészeti Osztály, Győr, Magyarország
| | - F Tamás Molnár
- 1Petz Aladár Egyetemi Oktató Kórház, Sebészeti Osztály, Győr, Magyarország
- 2Pécsi Tudományegyetem, Általános Orvosi Kar, Orvosi Készségfejlesztő és Innovációs Központ, Műveleti Medicina Tanszék, Pécs, Magyarország
| | - Zsófia Tokodi
- 3Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Onkológiai Osztály, Budapest, Magyarország
| | - György Bodoky
- 3Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Onkológiai Osztály, Budapest, Magyarország
| | - Dániel Kollár
- 1Petz Aladár Egyetemi Oktató Kórház, Sebészeti Osztály, Győr, Magyarország
| | - Attila Oláh
- 1Petz Aladár Egyetemi Oktató Kórház, Sebészeti Osztály, Győr, Magyarország
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Zhang LL, Rong XC, Yuan L, Cai LJ, Liu YP. Breast cancer with an initial gastrointestinal presentation: a case report and literature review. Am J Transl Res 2021; 13:13147-13155. [PMID: 34956535 PMCID: PMC8661181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/06/2021] [Indexed: 06/14/2023]
Abstract
The most common sites of breast cancer metastasis are the lymph nodes, lungs, bones, and liver. Gastrointestinal (GI) metastasis is relatively rare and often occurs within several years after a breast cancer diagnosis. Most patients experience abdominal pain, anorexia, bleeding, vomiting, and other digestive system symptoms, symptoms which are difficult to distinguish from primary gastric cancer. There is no characteristic change seen under a digestive tract endoscopy, and the difference in morphology under the pathological microscope from that of primary poorly differentiated gastric adenocarcinoma is so small that it can easily cause a misdiagnosis. This paper reports the case of 46-year-old female patient whose first symptom was GI discomfort. She was hospitalized for GI surgery with an unknown medical history, but, during the preoperative examination, multiple breast masses were found on both sides, which were proved by pathology to be invasive lobular cancer. According to the medical literature, bilateral breast cancer with gastric metastasis is very rare, and, so far, this is the first reported case. Despite it being a rare phenomenon, it is necessary to be aware of the possibility of metastatic lobular carcinoma in the diagnosis of poorly differentiated gastric adenocarcinoma by biopsy.
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Affiliation(s)
- Ling-Ling Zhang
- Department of Pathology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, P. R. China
| | - Xiao-Cui Rong
- Department of Radiology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, P. R. China
| | - Li Yuan
- Department of Endoscopy Room, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, P. R. China
| | - Li-Jing Cai
- Department of Pathology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, P. R. China
| | - Yue-Ping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, P. R. China
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Kaneko Y, Koi Y, Kajitani K, Ohara M, Daimaru Y. Asymptomatic solitary metastasis to the stomach from breast cancer: A case report. Mol Clin Oncol 2020; 13:75. [PMID: 33005409 PMCID: PMC7523290 DOI: 10.3892/mco.2020.2145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 09/01/2020] [Indexed: 12/20/2022] Open
Abstract
Distant metastases from breast cancer are frequently found in bones, lungs and the liver. Metastasis to the stomach is rare, and its clinical presentation remains unclear. The present report describes a case of isolated gastric metastasis from breast cancer identified by contrast-enhanced computed tomography (CT). A 45-year-old female patient underwent right mastectomy and axillary lymph node dissection after preoperative chemotherapy for right invasive lobular breast carcinoma T4bN2M0, stage IIIB. Postoperative radiotherapy and endocrine therapy with tamoxifen for 5 years were performed. CT for postoperative follow-up at 52 years old revealed thickening of the stomach wall. Although the patient was asymptomatic, erosive mucosa was observed on the gastric body during gastroscopy. The gastric lesion was immunohistochemically diagnosed as metastatic luminal disease from the breast cancer. Positron emission tomography/CT revealed no abnormal accumulation suggesting metastasis to other organs. Palbociclib and fulvestrant treatment were initiated for gastric metastasis. Invasive lobular breast carcinoma results in gastrointestinal metastasis, including the stomach, more frequently than invasive ductal breast carcinoma. However, most gastric metastases occur simultaneously with systemic metastases. Solitary metastasis to the stomach without symptoms as in this case has rarely been reported. The possibility of gastric metastasis should be considered among the differential diagnoses, even in the absence of symptoms, when gastrointestinal abnormalities are seen on CT in patients with a history of breast cancer.
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Affiliation(s)
- Yuki Kaneko
- Department of Breast Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
| | - Yumiko Koi
- Department of Breast Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
| | - Keiko Kajitani
- Department of Breast Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
| | - Masahiro Ohara
- Department of Breast Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
| | - Yutaka Daimaru
- Section of Pathological Research and Laboratory, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
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