Breast cancer is the mostly seen malignancy of women. Breast cancer causes lung, bone, liver and brain metastasis. On the other hand, gastric metastasis of breast cancer is a rarely seen metastasis. For this reason, it may be misdiagnosed or diagnosed after its morbid or mortal complications occurred. This may also result as a delay of breast cancers primary treatment. If occurred the best tool is immunohistochemical panels especially gross cystic disease fluid protein 15 (GCDFP-15) for exact diagnosis. In our case, a gastric metastasis of breast cancer is presented which was admitted with the acute abdominal findings caused by its result as gastric perforation and diagnosed by GCDFP-15 immunohistochemical panel.

IntroductionBreast cancer, which is the most diagnosed cancer among women, is a heterogeneous disease, consisting of numerous, distinct clinical and biological features. Breast cancer is a collection of different diseases with different risk factors, clinical presentations, pathological features, and treatment responses and outcomes. In order to classify different breast cancers, several parameters have been used. Tumor grade, Tumor Node Metastasis (TNM) staging, histological classification, existence of axillary lymph node metastasis, immunohistochemical biomarker characterization, and molecular profiling are the parameters used for classification of breast tumors (1).Histological type is derived from the growth pattern of the breast tumors. Specific morphological and cytological patterns are associated with distinctive clinical presentations and/or outcomes (2). The most common type of breast cancer is an invasive ductal carcinoma (IDC). In the last version of the World Health Organization classification, at least 17 distinct histological special types have been recognised and specialized types account for up to 25% of all breast cancers (3). Special or rare breast tumor terminology was first described in the study of Weigelt B. et al. (2). Although new treatment protocols depend on molecular findings, histological groups still carry important clinical implications (3). As the prevalence of special type breast cancer is low, not as many studies are concerned with the clinical and molecular characteristics of special type breast cancer (4). In this study, we aimed to describe the clinical features of special type breast cancer in our center. Eur J Breast Health 2018; 14: 17-22 DOI: 10.5152/ejbh.2017.3219 17 ABSTRACT Objective: Breast cancer is a heterogeneous disease with different histological types. Ductal breast cancer constitutes the vast majority of the breast cancers. However limited data are present in the rest of breast cancers called special or rare type breast cancers. Here in this study, we tried to describe the clinical features of special type breast cancers in our center. Characteristics of Special Type Breast Tumors in Our Center Materials and Methods:Retrospective descriptive study was performed in Kocaeli University School of Medicine, Department of General Surgery between January 2000 and January 2016. Women diagnosed with primary breast cancer other than ductal carcinoma were included to the study. In total, 101 patients were evaluated according to histologic types, molecular types, Tumor Node Metastasis (TNM) stages, and grades. Survival of the patients was also evaluated.Results: Medullary and metaplastic types showed basal type; tubular, mucinous, micropapillary carcinoma, cribriform, lobular and apocrine tumors showed luminal type molecular pattern. Neither the existence of ductal carcinoma nor any histologic types had any effects on survival. Apocrine tumors were presented in younger ages. Conclusion:Histologic types of breast cancer are closely related with the molecular types of t...

INTRODUCTIONRett syndrome is a progressive neurodevelopment disorder in which MECP gene mutations are responsible and might be related to cancer.PRESENTATION OF CASEA 22 year-old girl with Rett syndrome was hospitalized for abdominal distention and shock. Abdominal tenderness and distention were revealed in physical examination. Radiological investigations revealed sigmoid volvulus and colonic obstruction. Sigmoid volvulus, sigmoid colon perforation due to sigmoid cancer with liver metastasis were observed at laparotomy. Hartman procedure performed. The patient died on the second postoperative day.DISCUSSIONRett syndrome has several gastrointestinal pathologies related with inadequate parasympathetic control. Genetic mutations in methyl-CpG-binding protein 2 (MECP2) which has role in several cancer mechanisms is the reason of Rett syndrome. Colon cancer with the underlying gastrointestinal pathologies complicated our case.CONCLUSIONRett syndrome patients need a high level of concern for gastrointestinal emergencies with cancer risk.

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Adult intussusception, which is a rare condition, generally requires surgical treatment. A 25-year-old-male with abdominal pain was diagnosed as ileal intussusception with computerized tomography. The patient underwent diagnostic laparoscopy, laparoscopic small bowel resection and anastomosis. The pathologic evaluation revealed heterotopic gastric mucosa. Heterotopic gastric mucosa is rarely seen in ileum and is difficult to diagnose preoperatively. Excision is the choice of treatment. Laparoscopic treatment can be preferred in adult intussusception even in urgent cases.Key Words: Intussusception, laparoscopy, adult, heterotopic gastric mucosa Adult intussusception represents 5% of all intussusceptions. Almost 90% of adult cases of intussusception are secondary to pathological conditions such as carcinomas, Meckel's diverticulum, strictures or benign neoplasms which are usually discovered intraoperatively (1). Therefore, 70-90% of adult intussusception cases require surgery rather than decompression. A 25-year-old male was admitted to the hospital with a sudden-onset, severe abdominal pain, nausea and vomiting. He had experienced lowgrade episodes of intermittent abdominal pain for one year. The patient had undergone appendectomy 6 months ago. There was no history of gastrointestinal bleeding or jaundice. Physical examination revealed tenderness and guarding in the lower abdominal quadrants. The white cell blood count was 13.000/mm 3 and C-reactive protein 8.9 mg/dL. Abdominal ultrasound showed intussusception of bowel segments. Abdominal computerized tomography (CT) revealed ileoileal intussusception (Figure 1). There was no additional pathology in the CT examination. The patient underwent urgent surgery because of the risk of necrosis. First a diagnostic laparoscopy was performed. Intussusception of ileal segments was seen without any necrosis (Figure 2). No other intraabdominal pathology was observed. Laparoscopic ileal resection was performed for intussusception. Pneumoperitoneum was established via the 12 mm trocar which was inserted above the umbilicus. Then two 5 mm trocars (left lower quadrant, right lower quadrant) and one 10 mm trocar (right upper quadrant) were inserted. Endoscopic stapler was inserted from the 12 mm trocar. A small intestinal segment of approximately 10 cm long including the intussusception was resected (Video 1. See corresponding video/movie images at www.ulusalcerrahidergisi.org). Side-to side anastomosis was created by endoscopic stapler. Stapler entrance incision was sutured laparoscopically. Umbilicus trocar incision was extended up to 2 cm and the resected bowel segment was extracted. The duration of the operation was 80 minutes. The microscopic features of the resected segment revealed heterotopic gastric mucosa. The patient had an uneventful recovery; he passed flatus on postoperative day (POD) 3, commenced oral fluids on POD 4, and discharged on POD 5. The patient was evaluated with gastrointestinal contrast series 6 weeks after surgery and no other pathology was found. Hete...