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Alsobahi NA, Mohammed TA. Small bowel obstruction as first presentation of metastatic lobular breast cancer for pilgrim patient. Int J Surg Case Rep 2024; 120:109855. [PMID: 38865947 PMCID: PMC11258619 DOI: 10.1016/j.ijscr.2024.109855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE The most common cancer among females worldwide and in Saudi Arabia is breast cancer. Lobular breast carcinoma is the second most common subtype of breast cancer. There are different patterns of metastasis as ductal breast cancer spreads to the liver, lung, brain, and bone while the lobular subtype metastasizes to the gastrointestinal tract. CASE PRESENTATION A 69-year-old Indian pilgrim presented to the ER complaining of abdominal pain, vomiting, and abdominal distention admitted as a case of intestinal obstruction. CT scan demonstrated intestinal obstruction with transition zone at the terminal ileum. The patient underwent exploratory laparotomy where she was found to have a mass at the terminal ileum. Resection of around 8 cm of small bowel and primary anastomosis were done, histopathology revealed metastatic lobular breast carcinoma. CLINICAL DISCUSSION Patients with metastatic breast cancer to the gastrointestinal tract often present with nonspecific symptoms, while acute cases present with complications such as perforation. In a retrospective review of metastatic breast cancer, the majority metastasizes to the colon and rectum, while 19 % to the small bowel. Palliative surgery is considered the first-line treatment of complicated patients, while stable cases are referred to medical oncology. CONCLUSION Breast cancer is the second most common cancer leading to death and lobular subtype has more propensity to metastasize to the gastrointestinal tract compared to ductal breast cancer. Regarding patients presenting to the emergency bay, treating the emergency complaints is the standard management. For immigrant patients, we highly recommend creating a data system for sending histopathology reports to facilitate follow-up in their countries. CASE PRESENTATION A 69-year-old Indian pilgrim patient presented to the ER complaining of abdominal pain for 3 days associated with nausea and vomiting, not passing stool nor flatus was admitted as a case of intestinal obstruction. On examination patient was in pain with tachycardia, abdominal distended with generalized tenderness. Labs revealed metabolic alkalosis with hypokalemia. Abdomen X-ray showed signs of intestinal obstruction with multiple air-fluid levels and dilated small bowel loops. CT scan abdomen and pelvis with IV contrast reported (Figs. 1,2) distended ileum around 5 cm proximal to the transition zone at the terminal ileum with mild free fluid in the abdomen and pelvis. The patient underwent exploratory laparotomy where she was found to have a mass at the terminal ileum with the proximal loop dilated and distal loops collapsed, and further exploration showed enlarged mesenteric lymph nodes. Small bowel resection of around 8 cm and side to side anastomosis was done to relive the intestinal obstruction. Gross pathology showed a solid lesion protruding into the lumen measuring 1.5*1.5*1.5 cm, while the microscopic description consists of small cells with round ovoid nuclei which lack cohesion and appear individually dispersed through a fibrous connective tissue and arranged in single file linear cords that invade the stroma (Fig. 4) concluded as metastatic lobular carcinoma of the breast. Immunohistochemistry reported CK7 + ve, ER + ve, EMA + ve and CKAE1/AE3 + ve. The patient had an uneventful recovery, then she was discharged against medical advice and traveled to her country after two days before the histopathology result and she lost follow-up with us.
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Benabdallah R, Hernández-Pérez M, Pena-Burgos EM, Trueba Collado C, Tabernero da Veiga S. Late metastases: a rare cause of diarrhea. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38767008 DOI: 10.17235/reed.2024.10399/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
We present the case of a 64-year-old female with personal history of breast carcinoma diagnosed in 2011, treated and discharged from the Oncology service after 10 years disease-free who, 21 years after the diagnosis, undergoes a colonoscopy with biopsy sampling due to a 2-year period of diarrhea and weight loss, which histological study show infiltration of the large intestine's by breast carcinoma. Due to the usual lymphatic widespread, metastases of breast cancer in the gastrointestinal tract are extremely rare with nonspecific symptoms, long latency periods and poor prognosis.
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Affiliation(s)
- Rania Benabdallah
- Digestive Diseases, Hospital Universitario Príncipe de Asturias, Spain
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Kim KE, Lee HW, Bae SU. Rectal metastasis arising from breast cancer: a case report. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2024; 20:41-45. [PMID: 38988018 PMCID: PMC11261180 DOI: 10.14216/kjco.24007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/03/2024] [Accepted: 05/25/2024] [Indexed: 07/12/2024]
Abstract
Breast cancer is the most common cancer among women worldwide. Breast cancer often metastasizes to the regional lymph nodes, bone, brain, liver, and lungs, whereas gastrointestinal tract metastases are rare. Herein, we present a rare case of rectal metastasis from breast cancer that occurred during palliative chemotherapy. A 69-year-old female with a history of invasive ductal carcinoma, negative for hormonal receptors and positive for human epidermal growth factor receptor 2 (HER2) receptor, underwent various treatments, including neoadjuvant chemotherapy, breast-conserving surgery, and adjuvant therapy. Eight months postoperatively, the patient experienced axillary lymph node recurrence, requiring palliative chemotherapy. Despite ongoing treatment, metastatic lesions were confirmed in the lungs and pleura. During palliative chemotherapy, the patient developed anal pain, and subsequent examination revealed an infiltrating rectal lesion. Despite histological confirmation of metastatic breast carcinoma and tubular adenoma, a multidisciplinary decision was made regarding palliative chemotherapy over surgical intervention. Eribulin was administered, but due to the patient's inability to tolerate the treatment, she passed away 3 months after rectal lesion diagnosis. Although breast cancer metastasis to the rectum is rare, clinicians should consider the possibility of rectal involvement and perform a digital rectal examination if anal symptoms are present.
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Affiliation(s)
- Kyeong Eui Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu,
Korea
| | - Hye Won Lee
- Department of Pathology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu,
Korea
| | - Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu,
Korea
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Botto I, Moiteiro Cruz R, Noronha Ferreira C, Valente AI, Carrilho-Ribeiro L, Tato-Marinho R, Ferreira C, Correia L. Simultaneous Gastric and Colonic Metastasis of Breast Cancer. ACG Case Rep J 2023; 10:e01168. [PMID: 37811366 PMCID: PMC10553002 DOI: 10.14309/crj.0000000000001168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Although breast cancer (BC) is the most common malignancy in women, metastasization to the gastrointestinal tract is rare. We present a 59-year-old woman with simultaneous gastric and colonic metastasis of invasive lobular breast carcinoma. She had been diagnosed with BC and underwent surgery and systemic therapy. Two years later, an increase in tumor markers motivated investigation, including upper and lower gastrointestinal endoscopy, which identified gastric ulcers and mucosal irregularity in the cecum. Histopathological analysis was compatible with gastric and colonic metastases from BC. We highlight the importance of biopsying every endoscopically visible lesion in patients with BC history.
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Affiliation(s)
- Inês Botto
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Rafael Moiteiro Cruz
- Serviço de Anatomia Patológica, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
- Instituto de Histologia e Biologia do Desenvolvimento, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Noronha Ferreira
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Ana Isabel Valente
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Luis Carrilho-Ribeiro
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Rui Tato-Marinho
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Cristina Ferreira
- Serviço de Anatomia Patológica, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Luis Correia
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
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Kagawa D, Kotani M, Miyaguni T, Chibana T, Uezu I, Chinen Y, Maeshiro K, Ono R, Nagahama M, Kinjo I, Tomori H, Miyazato H, Arakaki K, Hokama A. Ileal Perforation Caused by Metastasis of Breast Carcinoma. Chonnam Med J 2023; 59:198-199. [PMID: 37840678 PMCID: PMC10570863 DOI: 10.4068/cmj.2023.59.3.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Daijiro Kagawa
- Department of Surgery, Naha City Hospital, Naha, Okinawa, Japan
| | - Mikako Kotani
- Department of Surgery, Naha City Hospital, Naha, Okinawa, Japan
| | - Takao Miyaguni
- Department of Surgery, Naha City Hospital, Naha, Okinawa, Japan
| | | | - Ippei Uezu
- Department of Surgery, Naha City Hospital, Naha, Okinawa, Japan
| | - Yoshiki Chinen
- Department of Surgery, Naha City Hospital, Naha, Okinawa, Japan
| | | | - Ryoko Ono
- Department of Surgery, Naha City Hospital, Naha, Okinawa, Japan
| | | | - Izumi Kinjo
- Department of Surgery, Naha City Hospital, Naha, Okinawa, Japan
| | - Hirofumi Tomori
- Department of Surgery, Naha City Hospital, Naha, Okinawa, Japan
| | | | - Kyoko Arakaki
- Department of Pathology, Naha City Hospital, Naha, Okinawa, Japan
| | - Akira Hokama
- Department of Medical Checkup, Naha City Hospital, Naha, Okinawa, Japan
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Jia J, Huang Y, Li X. Ascending colon metastasis after breast cancer surgery: a case report and literature review. Gland Surg 2023; 12:309-316. [PMID: 36915812 PMCID: PMC10005986 DOI: 10.21037/gs-22-642] [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: 10/09/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
Background Breast cancer is the most common cancer in women. The tumor is prone to metastasize in the brain, lung, liver, bone, and other organs; however, generally, it is less likely to metastasize in the digestive tract. Thus, breast cancer metastasizes to colon is rarely happened and easily ignored by clinicians. Such misdiagnosis may lead to delay the further diagnosis and treatment of patients, or even cause the life danger of patients due to the progress of the disease. Therefore, we propose such case reports to arouse clinicians' attention to the rare case of digestive tract metastasis after treatment of breast cancer. We also conducted a retrospective analysis of the relevant case reports. We suggest that because breast cancer with gastrointestinal metastasis rarely occurs, and because of the lack of specificity of syndromes, it is easily misdiagnosed. Thus, the attention of the receiving doctor needs to be drawn to this tumor. We also summarized the specificity and sensitivity of the commonly used immunohistochemical detection indicators of digestive tract metastasis of breast cancer. Case Description We presented a 67-year-old female went to hospital because of "acute pain in the right lower abdomen", after computed tomography (CT) examination, the patient was diagnosed as "acute appendicitis" and underwent laparoscopic appendectomy (LA), the post-surgery pathology confirmed metastatic carcinoma to the appendix from the breast that was removed 10 years early. The patient first came to our hospital 10 years ago because of the right breast malignant tumor. After modified radical mastectomy for right breast cancer, the patient underwent chemotherapy for 6 cycles. Tamoxifen endocrine therapy was administered after chemotherapy. The patient had a regular follow-up, with no signs of distant metastasis and local recurrence. Conclusions Metastasis from breast cancer to the gastrointestinal tract is extremely rare. For patients with breast cancer, endoscopy should be adopted as a routine follow-up item. For suspicious lesions found under endoscopy, immunohistochemistry stain should be adopted to ensure the diagnosis. For lesions that are confirmed to be metastatic from breast cancer, proper treatment should be carried out based on patients' condition to improve the prognosis.
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Affiliation(s)
- Jing Jia
- Department of Gastrointestinal Surgery, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
| | - Yisen Huang
- Department of Gastroenterology, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
| | - Xinyu Li
- Department of Gastrointestinal Surgery, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
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Katuwal B, Morin D, Kolachalam R. Gastrointestinal tract metastasis with subsequent intussusception and obstruction from an invasive lobular breast cancer: a case report. J Surg Case Rep 2023; 2023:rjac623. [PMID: 36654721 PMCID: PMC9838596 DOI: 10.1093/jscr/rjac623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
Breast cancer is the commonest cancer in female population with lobular subtype comprising about 10% of all breast cancers. Breast cancer metastasis occurs in 0.3-18% of patients, with lobular cancer again being the most common subtype. We present an 85-year-old female with previous history of right breast lobular carcinoma in situ (LCIS), who was diagnosed to have lobular carcinoma of breast metastasising to stomach after 10 years of initial diagnosis. After 2 years, the patient was found to have metastasis to the terminal ileum and caecum causing intussusception, which led to obstruction. The patient's primary LCIS was estrogen receptor (ER) positive, progesterone receptor (PR) negative and Her2neu negative, which correlated with both the gastric and ileocecal lesions. The gastric and ileocecal masses both were positive for CK7 and GATA 3 and negative for E-cadherin and CD20. Detailed morphological and immunohistochemical analysis can differentiate primary lobular cancer of the gastrointestinal tract from metastatic cancer.
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Affiliation(s)
- Binit Katuwal
- Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 49503, USA
| | - Donald Morin
- Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 49503, USA
| | - Ramachandra Kolachalam
- Correspondence address. Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 49503, USA. Tel: 248-662-4272; E-mail:
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Rectal metastasis originating from breast cancer: A rare case report. Ann Med Surg (Lond) 2022; 78:103841. [PMID: 35734715 PMCID: PMC9207094 DOI: 10.1016/j.amsu.2022.103841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
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Jabi R, Karich N, Ouryemchi M, Bennani A, Bouziane M. Hematemesis: An Exceptional Method of Revealing Gastric Metastasis From an Unknown Breast Cancer. Cureus 2021; 13:e18987. [PMID: 34820242 PMCID: PMC8607324 DOI: 10.7759/cureus.18987] [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] [Accepted: 10/23/2021] [Indexed: 11/06/2022] Open
Abstract
Breast cancer is a public health problem with an annual incidence exceeding two million new cases leading to its classification as first cancer in women. Its clinical presentation is variable and the palpation of a breast nodule allows the diagnosis to be suspected in the majority of cases. The treatment is multidisciplinary and has health, economic, and psychological impacts. We report a sporadic case of a 60-year-old woman followed for epigastralgia for three months. The current history of the present disease goes back to three days before her admission with the onset of several episodes of hematemesis motivating the patient to consult the ER and then get admitted to the ER for hematemesis. The initial clinical examination showed an epigastric sensitivity in a hemodynamically stable patient. The endoscopy revealed a gastric tumor and immunohistochemistry confirmed the gastric localization from a breast cancer unrecognized by the patient and discovered at the careful clinical examination after having stabilized the patient's condition.
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Affiliation(s)
- Rachid Jabi
- Department of General Surgery, Mohamed VI University Hospital, Faculty of Medicine and Pharmacy, Labarotory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation, Mohammed First University, Oujda, MAR
| | - Nassira Karich
- Department of Anatomopathology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, MAR
| | - Mouad Ouryemchi
- Department of General Surgery, Mohamed VI University Hospital, Faculty of Medicine and Pharmacy, Labarotory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation, Mohammed First University, Oujda, MAR
| | - Amal Bennani
- Department of Anatomopathology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, MAR
| | - Mohammed Bouziane
- Department of General Surgery, Mohamed VI University Hospital, Faculty of Medicine and Pharmacy, Labarotory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation, Mohammed First University, Oujda, MAR
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