Successful laparoscopic investigation and resection of solitary colonic metastasis from breast cancer (with video)

Abstract

Metastasis to gastrointestinal tract from breast cancer is an uncommon situation. We report a case of a 52-year-old woman who had a mastectomy for solid-tubular carcinoma of the breast 16 years ago and bilateral salpingo-oophorectomy for metastatic ovarian tumours 5 years ago, was incidentally found to have colonic metastatic tumour detected by positron emission tomography/CT (PET/CT) during follow-up. After identifying a definite location of the tumour in the ascending colon under laparoscopic investigation, laparoscopy-assisted partial colectomy was successfully performed. Histopathology of the resected specimen showed it to be metastasis from solid-tubular carcinoma of the breast. We should be aware that breast cancer can metastasise to the gastrointestinal tract even after the long interval from initial therapy. An index of high suspicion and detailed assessment is mandatory to make a correct diagnosis and following less invasive surgical treatment.

Figure 1

Preoperative findings. (A) Abdominal CT showing a mass in the ascending colon (arrows). (B) PET/CT scan showing a lesion of increased fluorine18-fluoro-deoxy-glucose uptake in the ascending colon wall. (C) Barium enema showing the partial defect of the ascending colon without stenosis. (D) Colonofiberscopy showing a submcosal mass protruded into the lumen without mucosal lesion.

Figure 2

Intraoperative findings and laparoscopic procedures. (A) Laparoscopy-assisted partial colectomy was performed using standard five-port access accompanied by additional 4 cm incision. (B) Under thorough observation through laparoscopy, the solitary tumour was found situated in the ascending colon. (C) After the right side of the colon was mobilised, the ascending colon was brought outside the abdomen and partial resection of the colon with the tumour was performed. (D) Resected specimens macroscopically demonstrated a 2 cm-sized clear round mass located between the submucosa and subserosa.

Figure 3

Histological examination revealed infiltration of the tumour cells in submucosa through subserosa, exhibiting nest-like pattern (the right lower inset, high-power magnification), and thus it was diagnosed as the recurrence of breast carcinoma (H&E, low-power magnification).