A 58-Year-Old Woman with Acute Gastric Perforation Due to Metastatic Ductal Carcinoma 18 Years Following Bilateral Mastectomy for Invasive Ductal Carcinoma of the Breast

Abstract

Patient: Female, 58-year-old Final Diagnosis: Gastric perforation Symptoms: Abdominal pain • peritonitis Medication: — Clinical Procedure: Jejunostomy tube placement • laparoscopic surgery • open surgery Specialty: Surgery Objective: Unusual clinical course Background: Invasive lobular carcinoma and ductal carcinoma of the breast can metastasize to all sites in the body, including the gastrointestinal tract. Late presentation of metastases of lobular carcinoma of the breast to the gastrointestinal tract have previously been reported, but late metastasis of ductal carcinoma of the breast to the gastric mucosa is rare. This report is of a 58-year-old Lebanese woman who presented with acute gastric perforation due to metastatic ductal carcinoma,18 years following bilateral mastectomy for invasive ductal carcinoma of the breast. Case Report: We present the case of a 58-year-old woman who underwent a right modified mastectomy for an invasive ductal carcinoma in 2002 combined with a contralateral prophylactic mastectomy for cosmetic purposes. She presented a secondary gastric lesion 18 years later. The clinical presentation resembled perforated ulcer. The choice of gastrectomy was denied due to retrogastric and pancreatic invasion by the tumor. A laparoscopic gastric closure failed to heal the perforation. A supraumbilical laparotomy incision was performed for the placement of a Pezzer tube in the gastric perforation and the installation of a feeding jejunostomy. Conclusions: This report is of a rare presentation of metastatic ductal carcinoma of the breast to the gastric mucosa associated with gastric perforation that presented 18 years after bilateral mastectomy. This case highlights the importance of obtaining a full past medical history to identify previous primary malignancy, and also is a reminder that ductal carcinoma of the breast can present with metastatic involvement in the gastrointestinal tract several months, or even years, following mastectomy.

Clinicopathological Features of 166 Cases of Invasive Ductal Breast Carcinoma and Effect of Primary Tumor Location on Prognosis after Modified Radical Mastectomy

“…IDC accounts for 70%–80% of invasive breast cancer, and patients are often accompanied by breast masses, pitting nipples, and other clinical manifestations [ 9 , 10 ]. At present, the main examination methods of IDC include mammography, color Doppler ultrasound, CT, and MRI [ 11 , 12 ]. The primary tumor is located in different locations and lymph node metastasis occurs at different rates.…”

Hematemesis: An Exceptional Method of Revealing Gastric Metastasis From an Unknown Breast Cancer

“…Thus Apodaca-Rueda M et al had reported a case of metastasis to the pancreatic level [ 11 ], Nour A et al, described a metastasis to both the colonic and gastric level initially taken as primary [ 12 ]. Other authors report digestive metastases of a breast primary discovered in a context of complication or emergencies like Théraux J et al who had described a colonic occlusion on a colonic tumor of breast origin [ 13 ] and Nehmeh WA et al had reported a secondary localization following a gastric perforation [ 14 ], while hematemesis revealed the diagnosis in our case. This sporadic case is described among less than 50 cases reported through the literature [ 14 ] and the treatment of its rare forms of GI metastases of breast origin is based on palliative chemotherapy [ 10 ] with a poor prognosis [ 4 ].…”