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

Abstract

Breast cancer metastases to the gastrointestinal tract are rare, with a median time interval from the diagnosis of the primary tumor to metastasis up to 7 years. The stomach is the most frequent metastatic site and invasive lobular carcinoma is the type with the highest affinity to the digestive system. We report the case of an 84-yearold female patient, with a past medical history 20 years earlier of invasive lobular carcinoma of the breast, who presented for dyspepsia. Upper endoscopy revealed hypertrophic gastric folds compatible with primary linitis plastica. Histology showed proliferation of malignant poorly cohesive cells. Immunohistochemistry stain showed intense positivity of estrogen receptors and anti-GATA-binding protein 3 nuclear antibodies, and absence of the human epidermal growth factor receptor 2. These findings confirmed the diagnosis of a metachronous metastasis of the invasive lobular breast adenocarcinoma. Considering metastases from breast cancer is crucial when patients with any subtle gastric symptom and a past medical history of invasive lobular adenocarcinoma of the breast seek medical advice, even though more than 20 years after primary breast cancer. Immunohistochemistry is the key to final diagnosis as these lesions can endoscopically and histologically mimic primary linitis plastica.

Rare Metastases in Colorectum of Infiltrating Ductal Breast Cancer: A Rare Case Report and Review

“…Besides, Ashley [22]thought surgical resection and histopathology are mandatory for diagnosis considering that colonoscopy biopsies may only capture normal mucosa. Some authors recommended more biopsies if the initial endoscopic result was negative and that it would yield a better diagnosis if assisted by endoscopic ultrasound-assisted fine needle aspiration [23].…”

Gastric metastases from invasive lobular carcinoma of the breast: Case report

“…For this reason, at the time of diagnosis, 60% of all patients will have lymph node or distant organ metastases [2] . IDC usually metastasize to local and distant lymph nodes, liver, lungs, brain, and bone [3 , 4] . In contrast, ILC shows a distinct systemic metastatic pattern and has a higher incidence of metastases to the gastrointestinal tract, gynecological organs, meninges, pleura, peritoneum, and skin [1] , [2] , [3] , [4] , [5] , [6] .…”

“…However, gastric metastases of lobular breast cancer are uncommon, with a reported incidence varying between 2.8% and 27% [2] . Gastric metastases can be diagnosed after a long period of time from primary tumor diagnosis (on average 7 years) [3] , [4] , [5] . The attributable symptoms are indistinguishable from the symptoms of a primary gastric cancer: Indigestion, dyspepsia, anorexia, pyrosis, nausea, epigastric pain, early satiety, vomiting, bleeding, and weight loss [1] , [2] , [3] , 7] .…”

“…Gastric metastases can be diagnosed after a long period of time from primary tumor diagnosis (on average 7 years) [3] , [4] , [5] . The attributable symptoms are indistinguishable from the symptoms of a primary gastric cancer: Indigestion, dyspepsia, anorexia, pyrosis, nausea, epigastric pain, early satiety, vomiting, bleeding, and weight loss [1] , [2] , [3] , 7] . In addition, the correct diagnosis may be difficult because metastatic disease involving the stomach is hard to differentiate from a primary gastric cancer on clinical, imaging, and pathological examinations [1 , 4 , 8] .…”

“…On pathologic examination of the gastric biopsies, the presence of signet ring-shaped cells may be interpreted as primary gastric cancer. Ultimately, the definitive diagnosis is based on immunohistochemical analysis and supported by previous clinical history [3] .…”