Gastric metastases from gynaecologic tumors: case reports and review of the literature

Abstract

The stomach is an infrequent localization of tumor metastases, and metastases originating from primary gynaecological cancers are particularly rare. We described the case of three females with ovarian, uterine, and breast metastases in the stomach, and we performed a systematic review of the literature of cases diagnosed at endoscopy. Overall, data of 18 patients with gastric metastases originating from the ovary, 11 from the uterus, and 159 from breast cancer were analyzed. Therefore, gastric metastasis mainly occurs from breast cancer, whilst both ovarian and uterine metastases are distinctly less frequent, but not impossible.

Gastric Metastasis Mimicking Linitis Plastica 20 Years after Primary Breast Cancer. A Case Report

“…In a review of 159 gastric metastases from breast adenocarcinoma, the mean age at diagnosis of the metastasis was 47 years whereas the median interval between the primary tumor and the secondary gastric location was 78 months (range, 33-96 months) [6]. Our patient was much older and had her primary breast lobular adenocarcinoma diagnosed 20 years earlier, which makes it an unusual case.…”

“…Symptoms are nonspecific and may range from dyspepsia (31%), loss of appetite, abdominal pain to vomiting and sometimes upper gastrointestinal tract obstruction [3,6,8]. Endoscopic findings are also nonspecific, as they may appear as mucosal ulcers, nodules, external compression and diffuse infiltration mimicking linitis plastica [6]. This latter is the most frequently described [9], in up to 73% of the cases [10].…”

“…In this context, a past medical history of lobular breast cancer led to further workup and, if the initial biopsies would not have been contributory, more biopsies should have been done to get tissue from the deeper layers of the stomach and possibly endoscopic ultrasound-fine needle aspiration (EUS-FNA) for a good tissue diagnostic yield. In fact, metastases to the stomach usually spread to the submucosal layer with a diffuse infiltrative pattern on endoscopy, without destruction of the mucosa which can give rise to false negative biopsies in almost 10% of the cases [6,11].…”

“…Abbreviations: CK: cytokeratin; ER: estrogen receptors; EUS-FNA: endoscopic ultrasound-fine needle aspiration; GATA3: GATA-binding protein 3; GCDFP-15: gross cystic disease fluid protein-15; HER2: human epidermal growth factor receptor 2; IHC: immunohistochemistry; PR: progesterone receptors. DOI: http://dx.doi.org/10.15403/jgld.2014.1121.274.gas uterus or the ovaries [6]. Lobular carcinoma of the breast has more affinity to the gastrointestinal tract than the other types [4], with an incidence of 4.5% compared to 0.2% in ductal carcinoma [7].…”

“…Lobular carcinoma of the breast has more affinity to the gastrointestinal tract than the other types [4], with an incidence of 4.5% compared to 0.2% in ductal carcinoma [7]. The mean time interval between the diagnosis of primary breast cancer and the appearance of gastric metastases usually ranges from 5 to 7 years [2,6,8].…”