Clinical features and prognosis of breast cancer with gastric metastasis

Abstract

Breast cancer rarely metastasizes to the gastrointestinal tract, including the stomach. Due to the rarity of this metastasis, it is occasionally confused with a primary stomach malignancy. However, discriminating characteristic features with clinical implications may exist. The aim of the current study was to analyze the clinical features and prognosis of breast cancer with gastric metastasis. Between January 1994 and October 2016, 13 patients at Samsung Medical Center (Seoul, Korea) were clinically or pathologically determined to have breast cancer with gastric metastasis. The present study retrospectively collected clinicopathological data from the electronic medical records of these 13 female patients. At breast cancer diagnosis, the median patient age was 45 years. A total of 7 patients (53.8%) presented with invasive lobular carcinoma (ILC) and 6 (46.2%) with invasive ductal carcinoma. Of the 13 patients, 11 were stage I-III at initial breast cancer diagnosis and underwent surgery. Positivity of breast cancer tissue samples for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) was 92.3, 76.9 and 0%, respectively. Positivity of gastric metastasis lesions, based on immunohistochemistry results, was 81.8, 50 and 0% for ER, PR and HER2, respectively. The stomach was the location of the first metastatic lesion in 6 out of the 11 patients (54.5%) with de novo stage I-III cancer. The median time interval from initial breast cancer diagnosis to stomach metastasis was 77.5 months. The 3-year survival rate was 79.1%, and the estimated mean survival time was 35.1 months. Breast cancer with gastric metastasis is rare, and due to this fact, a thorough pathological review and greater clinical suspicion are required in these cases.

Keywords: breast neoplasms; neoplasm metastasis; stomach neoplasms.

Figure 1.

Patient flow chart for collection of data. EGD, esophagogastroduodenoscopy.

Figure 2.

Time interval from breast cancer diagnosis to distant metastasis, and then to gastric metastasis and final follow-up. Each bar represents a patient with breast cancer and gastric metastasis. ^●,▲Time interval (months) from breast cancer to distant metastasis, and from distant metastasis to gastric metastasis, respectively. ^†The patient succumbed.

Figure 3.

OS rate among patients with breast cancer with gastric metastasis. OS, overall survival.

Figure 4.

Pathology of invasive lobular carcinoma of the breast. (A) Hematoxylin and eosin staining. (B) ER, (C) PR and (D) HER2 staining. ER and PR results were positive; however, HER2 results were negative. Magnification, ×200. HER2, human epidermal growth factor receptor 2; ER, estrogen receptor; PR, progesterone receptor.

Figure 5.

Pathology of gastric metastasis. (A) Hematoxylin and eosin staining. (B) ER, (C) PR and (D) HER2 staining. ER and PR results were positive; however, HER2 results were negative. Magnification, ×200. HER2, human epidermal growth factor receptor 2; ER, estrogen receptor; PR, progesterone receptor.

Figure 6.

Endoscopic results of gastric metastasis. (A) White discolored mucosal lesion with speculated edge. (B) Round polypoid lesions with or without ulceration. (C) Diffuse infiltrative lesion with spontaneous bleeding and fold thickening mimicking Bormann type IV. (D) Deep ulcerative lesion with yellowish exudate and spontaneous bleeding.

Figure 7.

Diffuse infiltrative lesion with hyperemic mucosal change in the remnant stomach following a Whipple procedure.