Metastasis to the stomach is very rare in the case of breast cancer (BC). The incidence rate of gastric metastasis (GM) is estimated to be about 0.3%. In general, the most common areas of BC metastasis are bone, liver, and lung. Retrospective studies have found that the majority of GM is derived from lobular breast cancer compared with other breast cancer subtypes and higher percentages are hormone positive. Previous studies suggest varying intervals between diagnosis of primary breast cancer and the detection of GM anywhere from 5 to 20 years. Unfortunately, published data is limited to single case reports or small series. Case Description/Methods: Patient is a 73 year old female past medical history of breast cancer initially diagnosed 13 years prior with stage IIB invasive right breast lobular carcinoma ER/PR positive, HER2 negative. Patient received right mastectomy and completed chemotherapy and radiation without evidence of metastasis. Subsequent imaging including PET scans revealed no evidence of disease. 10 years later biopsy of left breast showed moderately differentiated invasive carcinoma ER/PR positive, HER2 negative. Patient underwent mastectomy with node sampling that was negative for involvement. Patient was continued on chemotherapy. PET scan and brain MRI done 3 months prior to EGD showed no evidence of disease. Patient presented to our outpatient GI clinic with complaints of dysphagia. She had an episode of suspected food impaction relieved by vomiting. Patient was experiencing epigastric discomfort including occasional globus sensation for several months prior to the incident. EGD showed erythematous gastric mucosa with nodularity no obvious mass was found. Biopsies revealed ER/PR positive, HER2 negative, metastatic adenocarcinoma in gastric body and antrum. Patient decided not to pursue aggressive measures in regards to metastasis. She was started on PPI twice daily which helped alleviate epigastric symptoms. Repeat EGD showed improvement of gastritis (Figure 1). Discussion: Reports on GM from breast cancer are limited do to the rarity. In reviewing previous studies there is a similar theme. GM presents without other signs of metastasis. Our patient had multiple negative scans falsely suggesting no metastasis. Although infrequent, physicians should still consider the possibility of GM in patients with breast cancer and non specific GERD symptoms. More so in patients with history of lobular carcinoma and hormone positive subtypes.[3699] Figure 1. Endoscopic imaging of gastric metastasis.

Introduction: Small cell carcinoma most commonly originates in the lung. Colorectal small cell carcinoma is very rare, comprising 0.2% of all colorectal cancers. The incidence of small cell lung cancer (SCLC) was found to be 22-times that of extrapulmonary small cell cancer. Colorectal SCC is highly aggressive and carries a poor prognosis. Case Description/Methods: Patient is a 42-year-old female with a history of GERD and tobacco abuse who presented for rectal pain, 2 episodes of rectal bleeding, and a 2-month history of worsening constipation. She also endorsed night sweats, fatigue, nausea, and poor appetite. CT abdomen/pelvis showed a perirectal mass measuring 3.3 3 2.2 cm with adjacent mildly enlarged lymph nodes (Figure 1a). Colonoscopy then showed an eroded, nodular, and ulcerated mucosa in the distal rectum (Figure 1b). The mass was biopsied and pathology revealed small cell carcinoma (Figure 1c). Sigmoidoscopy with EUS and rectal biopsy confirmed poorly differentiated small cell carcinoma. Immunohistochemistry revealed that the tumor cells were positive for CD56 (Figure 1d), chromogranin, AE1/AE3 and TTF1. MRI showed T4N2 disease with possible involvement of the left levator muscle in addition to positive suspicious left inguinal lymph nodes. Patient was started on cisplatin and etoposide therapy. Discussion: Small cell carcinoma accounts for 0.1% to 1% of all GI malignancies, with the mean age at diagnosis of 60 years old. Symptoms of rectal small neuroendocrine cancers are similar to those of rectal adenocarcinomas including defecation difficulties, anal discomfort and blood per rectum. Most patients present with distant metastasis on presentation and have generalized symptoms of malignancy including fatigue, weight loss, and anorexia. The prognosis of colorectal SCC is generally poor. The rate of lymph node and liver metastases in colorectal SCC patients are 60%-89% and 20%-71%, respectively. Median survival in previous studies was 11 months with palliative chemotherapy and 1 month with best supportive care (BSC) only. Based on their established role in metastatic SCLC, cisplatin and etoposide have been one of the most widely used regimens in gastroenteropancreatic NEC, improving median survival to around one year. Curative surgery is usually attempted in localized disease, although retrospective series indicate that it is rarely curative as a sole therapeutic modality. Given the high relapse rate observed following radical surgery, platinum-based adjuvant therapy is recommended.[2085] Figure 1. (a) CT scan demonstrating perirectal mass measuring 3.3 3 2.2 cm concerning for metastases with adjacent mildly enlarged lymph nodes. (b) Colonoscopy image showing an eroded, nodular and ulcerated mucosa in the distal rectum. (c) H&E staining at 103 magnification demonstrating the rectal tumor (black arrow) adjacent to normal rectal tissue d. demonstrates Special staining demonstrating positive CD56 tumor cells.