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Case Reports
. 2018 May;97(21):e10888.
doi: 10.1097/MD.0000000000010888.

Colonic metastasis from breast carcinoma detection by CESM and PET/CT: A case report

Giuseppe Falco  1 , Simone Mele, Maurizio Zizzo, Graziella Di Grezia, Paolo Cecinato, Giulia Besutti, Saverio Coiro, Gianluca Gatta, Rita Vacondio, Guglielmo Ferrari
Affiliations
Case Reports

Colonic metastasis from breast carcinoma detection by CESM and PET/CT: A case report

Giuseppe Falco et al. Medicine (Baltimore). 2018 May.

Abstract

Introduction: Metastatic spread in invasive lobular carcinoma (ILC) of breast mainly occurs in bones, gynecological organs, peritoneum, retroperitoneum, and gastrointestinal (GI) tract. Metastases to the GI tract may arise many years after initial diagnosis and can affect the tract from the tongue to the anus, stomach being the most commonly involved site. Clinical presentations are predominantly nonspecific, and rarely asymptomatic. CEA, CA 15-3, and CA 19-9 may be informative for symptomatic patients who have had a previous history of breast cancer.

Case presentation: We introduce the case of asymptomatic colonic metastasis from breast carcinoma in a 67-year-old woman followed-up for Luminal A ILC. Diagnosis was performed through positron emission tomography/computed tomography (PET/CT) scan and contrast-enhancement spectral mammography (CESM), steering endoscopist to spot the involved intestinal tract and in ruling out further dissemination in the breast parenchyma.

Conclusion: In colonic metastases, tumor markers might not be totally reliable. In asymptomatic cases, clinical conditions might be underappreciated, missing local or distant recurrence. CT and PET/CT scan might be useful in diagnosing small volume diseases, and steering endoscopist toward GI metastasis originating from the breast. CESM represents a tolerable and feasible tool that rules out multicentricity and multifocality of breast localization. Moreover, particular patients could tolerate it better than magnetic resonance imaging (MRI).

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Conflict of interest statement

The authors declare that they have no conflict of interest or financial ties to disclose.

Figures

Figure 1
Figure 1
18F-FDG PET/CT: Axial and coronal 18F-FDG PET/CT images showing focal FDG uptake in the region of ileocecal valve with a maximum SUV of 4.7 (1A) and a focal FDG uptake in correspondence of right breast axillary tale with a SUV of 1.9 (1B).
Figure 2
Figure 2
Colonoscopy: Diagnostic colonoscopy images show a nonspecific, protruding, hyperemic, nonulcerated colonic wall area, near the ileocecal valve (black arrows). The biopsy of this area revealed the presence of a lobular breast cancer metastasis.
Figure 3
Figure 3
Contrast-enhanced spectral mammography: Mediolateral oblique recombined image showed faint enhancement (red circle) visible in the right axillary breast tale.
Figure 4
Figure 4
Ultrasound: Minute ipoechoic area of 4 mm visible at the second ultrasound look.
See this image and copyright information in PMC

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