Widespread metastatic breast cancer to the bowel: an unexpected finding during colonoscopy

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Abstract

Metastatic neoplasms to the gastrointestinal (GI) tract are an uncommon entity and in extremely rare cases originate from the breast. The clinical manifestations of metastatic breast cancer into the GI tract are frequently non-specific, and the interval between the diagnosis of lobular carcinoma and GI metastasis can often delay up to 30 years. Here, we present a 73-year-old female with an unusual colonoscopy that revealed a submucosa nodular infiltrate throughout all the colon with a cobblestone-like appearance, which was later confirmed to be metastatic lobular carcinoma of the breast that was surgically removed 15 years early. A couple of months later, she developed malignant small bowel obstruction and laparotomy revealed extended small bowel and colonic metastatic involvement.

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Metastatic lobular carcinoma of the breast masquerading as a primary rectal cancer

Ikuo Matsuda, Nagahide Matsubara, Nobuo Aoyama … (2012)

Background Colorectal metastasis of lobular carcinoma of the breast is a diagnostic challenge. It may macroscopically simulate primary colon cancer or inflammatory bowel disease. In some cases, the interval between the primary breast cancer and metastatic colorectal lesions is so long that the critical records for diagnosis including history might be lost or missed. Case presentation Reported herein is a case of metastatic lobular carcinoma of the breast masquerading as a primary rectal cancer developed in a 62-year-old Japanese woman. The case initially presented as a circumferential rectal lesion, and information on the patient’s history of breast cancer was not noted. As the result of endoscopic biopsy, diagnosis of poorly differentiated rectal adenocarcinoma was made. The lesion was surgically resected after chemo-radiotherapy. Histopathological examination of the resected specimen with hematoxylin and eosin (HE) stain revealed a single-file arrangement of the tumor cells, reminiscent of lobular carcinoma of the breast. Immunohistochemical analysis revealed an immunophenotype consistent with lobular carcinoma of the breast. Because further review of the patient’s history revealed an occurrence of ‘poorly differentiated adenocarcinoma of the breast’, which she had experienced 24 years earlier, the final diagnosis of the lesion was made as rectal metastasis from lobular breast carcinoma. Conclusions Poorly differentiated adenocarcinoma of the colorectum is rarer than that of the stomach. Linitis plastica-type cancer of the colorectum is also rarer than that of the stomach. A lesson from the present case is that before we conclude a linitis plastica-type cancer of poorly differentiated type as a primary colorectal cancer, it is critical to exclude a possibility of metastatic colorectal cancer.

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An Unusual Clinical Presentation of Gastrointestinal Metastasis From Invasive Lobular Carcinoma of Breast

Bathmapriya Balakrishnan, Sufiya Shaik, Irina Burman-Solovyeva (2016)

Introduction. We present an unusual case of metastatic lobular breast carcinoma. Typical areas of metastasis include bone, gynecological organs, peritoneum, retroperitoneum, and gastrointestinal (GI) tract, in order of frequency. With regard to GI metastasis, extrahepatic represents a rare site. Case. Two years after being diagnosed with invasive lobular breast carcinoma, a 61-year-old female complained of 3 months of nonspecific abdominal pain and diarrhea. A colonoscopy revealed 5 tubular adenomatous polyps in the ascending and transverse colon. Contrast computed tomography (CT) of the abdomen and pelvis was done 7 months after the colonoscopy to further evaluate persistent diarrhea. The CT results were consistent with infectious or inflammatory enterocolitis. Despite conservative management, symptoms failed to improve and a repeat diagnostic colonoscopy was obtained. Random colonic biopsies revealed metastatic high-grade adenocarcinoma of the colon. Discussion. Metastatic lobular breast carcinoma to the GI tract can distort initial interpretation of endoscopic evaluation with lesions mimicking inflammation. The interval between discovery of GI metastasis and diagnosis of lobular breast cancer can vary widely from synchronous to 30 years; however, progression is most often much sooner. Nonspecific symptoms and subtle appearance of metastatic lesions may confound the diagnosis. A high index of suspicion is needed for possible metastatic spread to the GI tract in patients with a history of invasive lobular breast carcinoma. Perhaps, patients with nonspecific GI symptoms should have an endoscopic examination with multiple random biopsies as invasive lobular carcinoma typically mimics macroscopic changes consistent with colitis.

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Author and article information

Journal

Journal ID (nlm-ta): Oxf Med Case Reports

Journal ID (iso-abbrev): Oxf Med Case Reports

Journal ID (publisher-id): omcr

Title: Oxford Medical Case Reports

Publisher: Oxford University Press

ISSN (Electronic): 2053-8855

Publication date Collection: February 2019

Publication date (Electronic): 16 February 2019

Publication date PMC-release: 16 February 2019

Volume: 2019

Issue: 2

Electronic Location Identifier: omy133

Affiliations

[1 ]Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Campus Norte, Edo. de México, Mexico

[2 ]Department of Colon and Rectal Surgery, North Memorial Health, Minneapolis, MN, USA

[3 ]Department of Pathology, North Memorial Health, Minneapolis, MN, USA

[4 ]Department of Gastroenterology, North Memorial Health, Minneapolis, MN, USA

Author notes

Correspondence address. Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Campus Norte, Av. Universidad Anáhuac No 46, Colonia Lomas Anáhuac, Huixquilucan, Edo. de México 52786, Mexico. Tel: +52-55-56270210; E-mail: rubenblach@ 123456gmail.com

Article

Publisher ID: omy133

DOI: 10.1093/omcr/omy133

PMC ID: 6380529

PubMed ID: 30800329

SO-VID: fc5f525b-ed13-48c8-852e-1f476b68e09a

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

History

Date received : 11 October 2018

Date revision received : 01 December 2018

Date accepted : 25 December 2018

Page count

Pages: 2

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