Metastatic breast cancer to the gastrointestinal tract: a case series and review of the literature

Abstract

Metastatic breast cancer involving the hepatobiliary tract or ascites secondary to peritoneal carcinomatosis has been well described. Luminal gastrointestinal tract involvement is less common and recognition of the range of possible presentations is important for early and accurate diagnosis and treatment. We report 6 patients with a variety of presentations of metastatic breast cancer of the luminal gastrointestinal tract. These include oropharyngeal and esophageal involvement presenting as dysphagia with one case of pseudoachalasia, a linitis plastica-like picture with gastric narrowing and thickened folds, small bowel obstruction and multiple strictures mimicking Crohn's disease, and a colonic neoplasm presenting with obstruction. Lobular carcinoma, representing only 10% of breast cancers is more likely to metastasize to the gastrointestinal tract. These patients presented with gastrointestinal manifestations after an average of 9.5 years and as long as 20 years from initial diagnosis of breast cancer. Given the increased survival of breast cancer patients with current therapeutic regimes, more unusual presentations of metastatic disease, including involvement of the gastrointestinal tract can be anticipated.

Figure 1

Barium swallow demonstrating smooth, symmetric tapering of the esophagus (arrow), suggesting achalasia.

Figure 2

Saggital T1-weighted MRI demonstrating low-signal consistent with marrow replacement at both C1 and the posterior vertebral body of C3 (arrow) (A), and low-signal soft tissue mass adjacent to the C2 vertebral body (arrow) (B).

Figure 3

Barium swallow demonstrating irregular stenosis (arrow) involving the middle esophagus.

Figure 4

Double-contrast upper GI examination demonstrating irregular narrowing of the gastric antrum (arrow) (A), CT demonstrating gastric mural thickening, perigastric stranding, (arrow) and lymphadenopathy (B).

Figure 5

Small bowel enteroclysis showing persistent narrowing of the gastric body and antrum (arrow), prominent irregular gastric rugae with diffuse mucosal serration, and strictures of the ileum.

Figure 6

CT demonstrating a dilated loop of small bowel (arrow) and ascites (A), double-contrast barium enema demonstrating fixed eccentric strictures of the ascending colon and splenic flexure (arrows) with a third obscuring lesion seen within the sigmoid colon but not projected in profile on this image (B).