Metastatic breast carcinoma presenting as persistent diarrhea

Abstract

Patients with breast carcinoma metastatic to the colon generally present with multiple symptoms, usually pain, vomiting, nausea, and ascites. We describe a patient who presented only with persistent diarrhea, underwent surgery for colon cancer, and, on pathological evaluation of the surgical specimen, was found to have metastatic breast cancer affecting the colon. Metastatic breast cancer should therefore be suspected in patients with a history of breast cancer and diarrhea of unknown cause that is not accompanied by other symptoms. Evaluating such patients by colonoscopy and biopsy would provide important information relevant to choosing between colon surgery and systemic therapy.

Metastatic breast adenocarcinoma masquerading as colonic primary. Report of two cases

“…Most reports referred metastasis of breast carcinoma to the stomach rather than the colon [1,4]. In different autopsy studies the incidence rate of gastrointestinal metastasis varies from 3% to 4.5% [5]. The disease-free interval between primary breast cancer and gastrointestinal involvement varies from synchronous presentation up to 30 years [1].…”

“…In our case one patient had profound anaemia and weakness for the last month, and the other presented with symptoms of bowel obstruction. There is one report that it was persistent diarrhoea that lead to the diagnosis, while others describe abdominal pain, vomiting, nausea, hematemesis, dysphagia, melena, weight loss and anorexia [5]. There are also reports presenting cases with metastasis with symptoms of inflammatory bowel disease, ulcerative colitis or Crohn's disease.…”

“…Radiological diagnosis at early stage of colonic metastasis is difficult, as there are no substantial changes in the colon. At a later stage, as the disease progresses, double-contrast barium enema may show mucosal thickening and nodularity, multiple strictures and loss of the haustral pattern [5]. None of these things are specific for breast cancer metastasis to the colon, so it has to be the pathological evaluation of specimens obtained with colonoscopy or surgical operation that will confirm the diagnosis [2,5].…”

“…At a later stage, as the disease progresses, double-contrast barium enema may show mucosal thickening and nodularity, multiple strictures and loss of the haustral pattern [5]. None of these things are specific for breast cancer metastasis to the colon, so it has to be the pathological evaluation of specimens obtained with colonoscopy or surgical operation that will confirm the diagnosis [2,5]. Comparisons of the resected colon tumour with the original breast cancer, and positive reaction for cytokeratine and oestrogen receptors are strong evidence of breast cancer metastasis [7].…”

Can Metastatic Breast Cancer Spread to the Colon?

“…It is because lobular carcinoma shows distinct histological and biological features, such as inactivation of E-Cadherin [4] that leads to lack of cohesiveness between cells and typically has slow growing behavior due to HER2-negativity [5]. The clinical presentation of colonic metastases is very nonspecific and ranges from abdominal pain, intestinal obstruction to rarely as inflammatory diarrhea [6,7]. GI metastasis of breast carcinoma is a challenging situation for the physician.…”