Breast cancer with an initial gastrointestinal presentation: a case report and literature review

Abstract

The most common sites of breast cancer metastasis are the lymph nodes, lungs, bones, and liver. Gastrointestinal (GI) metastasis is relatively rare and often occurs within several years after a breast cancer diagnosis. Most patients experience abdominal pain, anorexia, bleeding, vomiting, and other digestive system symptoms, symptoms which are difficult to distinguish from primary gastric cancer. There is no characteristic change seen under a digestive tract endoscopy, and the difference in morphology under the pathological microscope from that of primary poorly differentiated gastric adenocarcinoma is so small that it can easily cause a misdiagnosis. This paper reports the case of 46-year-old female patient whose first symptom was GI discomfort. She was hospitalized for GI surgery with an unknown medical history, but, during the preoperative examination, multiple breast masses were found on both sides, which were proved by pathology to be invasive lobular cancer. According to the medical literature, bilateral breast cancer with gastric metastasis is very rare, and, so far, this is the first reported case. Despite it being a rare phenomenon, it is necessary to be aware of the possibility of metastatic lobular carcinoma in the diagnosis of poorly differentiated gastric adenocarcinoma by biopsy.

Keywords: Bilateral breast cancer; invasive lobular carcinoma of the breast; metastatic carcinoma of the digestive tract.

Figure 1

Gastroscopic manifestations: congestion, and swelling of the mucosa, central erosions, and depression.

Figure 2

Molybdenum-based imaging showed multiple diffuse, irregular masses and non-mass-like lesions in both breasts with clear nonhomogeneous enhancement, and some lesions had sharp or burred edges (Red arrows).

Figure 3

Gastric body mucosa biopsy. The microscopy findings were as follows: cancer cells in the gastric mucosa were arranged in sheets, infiltrating the gastric mucosa glands (HE ×100).

Figure 4

Gastric antrum mucosa biopsy. The cells were moderately heteromorphic, some nuclei were eccentric, the cells had rich cytoplasms, and intracellular mucus could be seen (HE ×200).

Figure 5

The CK7 was diffusely strongly positive (IHC EnVision, ×400).

Figure 6

The ER was strongly positive (IHC EnVision ×400).

Figure 7

The PR was strongly positive (IHC EnVision ×400).

Figure 8

The GATA3 staining (IHC EnVision, ×400).

Figure 9

The histology of the left axillary mass (HE ×400).

Figure 10

The histological examination of the right breast tumor showed that the tumor cells were dense and moderately heteromorphic and had slightly hyperchromatic cytoplasms (HE ×200).

Figure 11

In the left breast biopsy sample, the tumor cells were sparse, arranged in cords, with a beaded structure in some parts, and had less heteromorphism than the cells in the right breast biopsy sample (HE ×200).

Figure 12

The E-cadherin protein was absent (IHC EnVision, ×200).

Figure 13

P120 was positive in the cytoplasm (IHC EnVision, ×200).