Breast cancer metastasis to the stomach may mimic primary gastric cancer: report of two cases and review of literature

Jones, Greg; Strauß, D.; Forshaw, Matthew; Deere, Harriet; Mahedeva, Ula; Mason, Robert C.

doi:10.1186/1477-7819-5-75

Cited by 82 publications

(104 citation statements)

References 30 publications

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“…As CDX2 is a sensitive and relatively specific marker for intestinal differentiation that has been reported to be expressed in the majority of signet-ring cell carcinomas of the colon (90-100%) 8,61 and less frequently in the stomach (B45%), 8,62 but not in mesotheliomas, immunostaining for this marker, especially when it is used in conjunction with other markers, such as keratin 20, which is frequently expressed in colonic (B85%) 10 and gastric (B45%) 10 signet-ring cell carcinomas, but usually absent in mesotheliomas, can be useful in assisting in discriminating signet-ring cell carcinomas of the gastrointestinal tract from signetring cell mesotheliomas. Signet-ring cell carcinomas of the breast can be distinguished from signet-ring cell mesotheliomas by the combined use of breastassociated markers, such as mammaglobin and gross cystic disease fluid protein-15, estrogen receptor, which has been reported to be frequently positive in signet-ring cell breast carcinomas, but negative in signet-ring cell mesotheliomas, 8,63,64 and mesothelioma markers, such as WT1 and podoplanin, which are frequently expressed in mesotheliomas, but negative in breast carcinomas. 65 Although signet-ring cell mesotheliomas can be confused with metastatic signet-ring cell carcinomas, it should be kept in mind that the presence of signet-ring cell morphology is not a feature that is exclusively seen in epithelial tumors, as other neoplasms, such as epithelioid hemangioendotheliomas 66 and melanomas, [67][68][69] can, on occasion, exhibit this morphology.…”

Section: Markermentioning

confidence: 99%

Mesothelioma with signet-ring cell features: report of 23 cases

Ordóñez

2013

Modern Pathology

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Signet-ring cell mesothelioma is uncommon and only two case reports have been published on this mesothelioma variant, both of which were initially misdiagnosed as signet-ring cell carcinoma. Herein are reported 23 signet-ring cell mesotheliomas that were investigated by immunohistochemistry, 12 of which were also studied by electron microscopy. Twenty-one of the cases originated in the pleura and two in the peritoneum. For comparison purposes and in order to determine the value of these techniques in the differential diagnosis of these tumors, seven cases of signet-ring cell lung adenocarcinoma were also studied. All signetring cell mesotheliomas were positive for calretinin, keratin 5/6, keratin 7, and mesothelin, 93% for podoplanin, and 91% for WT1; whereas, none reacted for MOC-31, CEA, TAG-72, CD15, TTF-1, napsin A, or CDX2. Among signet-ring cell lung adenocarcinomas, 100% were positive for keratin 7, CEA, and napsin A, 86% each for TTF-1 and TAG-72, 71% for CD15, and 14% for mesothelin, while all were negative for calretinin, keratin 5/6, WT1, podoplanin, and CDX2. After analyzing the results, it is concluded that the panels of markers used in the differential diagnosis of this mesothelioma variant should include those markers that are usually expressed in mesotheliomas (eg, calretinin, keratin 5/6, WT1, and podoplanin), broad-spectrum carcinoma markers that are frequently expressed in adenocarcinomas regardless of their site of origin (eg, MOC-31 and CEA), and organ-associated markers (eg, TTF-1 and napsin A for lung), which allow the site of origin of a metastatic adenocarcinoma to be established. Electron microscopy can be very useful as it permits the identification of characteristic ultrastructural mesothelioma and adenocarcinoma markers, and it also allows a better understanding of the morphologic features seen on routine light microscopy. Pathologists should be aware of this mesothelioma subtype as it can potentially be confused with other tumors that exhibit signet-ring features. Modern Pathology (2013) 26, 370-384; doi:10.1038/modpathol.2012.172; published online 5 October 2012Keywords: electron microscopy; immunohistochemistry; signet-ring cell carcinoma; signet-ring cell mesotheliomaThe finding of occasional vacuolated cells exhibiting signet-ring-like morphology is not rare in mesotheliomas; however, epithelioid mesotheliomas having a large number of such cells are relatively uncommon and have been subclassified as signet-ring cell mesotheliomas. 1 Signet-ring cell carcinomas can arise in a wide variety of organs, including lung, 2-6 stomach, 7,8 colon, 8-10 breast, 8,11,12 urinary bladder, 13-17 pancreas, 18 salivary glands, 19 and prostate. [20][21][22][23][24][25][26][27][28] The signet-ring configuration seen in adenocarcinomas has traditionally been associated with the accumulation of large amounts of intracytoplasmic mucin. It can also occur as a result of the formation of a true intracytoplasmic lumen with displacement of the nucleus toward the periphery of the cell, in which case, spe...

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Section: Markermentioning

confidence: 99%

Mesothelioma with signet-ring cell features: report of 23 cases

Ordóñez

2013

Modern Pathology

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“…Typically, invasive lobular breast carcinoma is the breast cancer type that most likely metastasizes to the gastrointestinal tract [6–9]. In this case, the patient had metastatic ductal carcinoma, which is unusual as it typically exhibits solitary metastases and is far less likely to metastasize to the gastrointestinal tract in a diffuse pattern [8–10]. Documented case reports of metastases to the stomach or to the pancreas have been cited; however, an invasive ductal adenocarcinoma of the breast with simultaneous metastases to both the pancreas and stomach have not been reported.…”

Section: Discussionmentioning

confidence: 99%

Metastasis to the pancreas and stomach from a breast cancer primary: a case report

Kliiger¹,

Gorbaty

2017

Journal of Community Hospital Internal Medicine Perspectives

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A 60-year-old female with an unknown family history initially presented with signs and symptoms concerning for gastrointestinal cancer. Regular breast cancer screening and subsequent work-up around this time demonstrated the presence of T2N1 stage II triple positive ductal adenocarcinoma of the left breast. Follow-up imaging for her gastrointestinal symptoms demonstrated a 3.5 cm solitary mass in the pancreas and diffuse thickening of the stomach wall. Biopsies of the gastrointestinal lesions were identified as metastatic foci of the breast cancer primary. Breast cancer metastases to the stomach and to the pancreas are both very rare events. Of the breast cancer primaries that do metastasize to the gastrointestinal system, it is unusual for the primary to be ductal adenocarcinoma. The rapid succession of diagnosing the primary source of breast cancer simultaneously with its metastases is also unusual. Timely identification and appropriate management of these rare metastases was made possible due to routine breast cancer screening.

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“…Diffuse type gastric adenocarcinomas and lobular carcinomas of the breast share a variety of cytomorphologic features, such as a single cell growth pattern and a signet ring cell appearance. However, primary and metastatic carcinomas of the GI tract have significantly different treatment and prognoses [8]. Detailed IHC study is the most helpful method in this case.…”

Section: Discussionmentioning

confidence: 99%

Synchronous Orbital and Gastric Metastasis of Invasive Lobular Breast Carcinoma, Mimic Primary Gastric Carcinoma-Case Report

Choi¹,

Shin²,

Song³

et al. 2016

Gen Med

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Breast carcinoma is the most common primary origin of orbital metastasis. Orbital metastasis occurs through hematogenous spread and predominantly involves the choroid. On the other hand, breast carcinoma metastasis to the stomach is relatively rare. Invasive lobular carcinoma has a high tendency to metastasis to the stomach than ductal carcinoma. We present a case of invasive lobular carcinoma of breast with synchronous presentation of orbital and gastric metastasis. Gastroscopy revealed diffuse schirrous mass with pyloric obstruction and the biopsy was poorly differentiated carcinoma, mimic primary gastric malignancy. But on immunohistochemistry, both orbital and gastric mass showed hormonal receptor positivity that is agreement with primary breast lesion. Clinical suspicion, repeated endoscopic procedures, and intimate histologic analysis including immunohistochemistry is necessary for appropriate diagnosis, which might help to avoid unnecessary surgical procedure owing to incorrect diagnosis.

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Breast cancer metastasis to the stomach may mimic primary gastric cancer: report of two cases and review of literature

Cited by 82 publications

References 30 publications

Mesothelioma with signet-ring cell features: report of 23 cases

Mesothelioma with signet-ring cell features: report of 23 cases

Metastasis to the pancreas and stomach from a breast cancer primary: a case report

Synchronous Orbital and Gastric Metastasis of Invasive Lobular Breast Carcinoma, Mimic Primary Gastric Carcinoma-Case Report

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