State University of New York Downstate Medical Center Brooklyn, NY, United States
Vimal Bodiwala, MD1, Akhtar Cheema, MD2, Elliot Bigajer, DO2 1State University of New York Downstate Medical Center, Brooklyn, NY; 2Brookdale University Hospital, Brooklyn, NY
Introduction: Breast cancer metastases to the gastrointestinal tract including the stomach and colon are infrequent. The estimated incidence rate of breast cancer metastases to the stomach is 0.3%.1 Breast cancer metastatic to the colon is considered even rarer; metastases to the colon may resemble primary colon cancer.2 We present a case report of a woman diagnosed with breast cancer metastases to the stomach and colon.
Case Description/Methods: 67 year old woman was admitted to the hospital for symptomatic anemia. Her medical history was noted for recent diagnosis of breast cancer, COPD, type 2 diabetes and hypertension. She did not report any melena, hematochezia or hematemesis. She was found to have hemoglobin of 5.5 g/dL with ferritin of 20 ng/mL. Rectal exam showed brown stools. Two months prior to her admission, patient was diagnosed with invasive ductal and lobular carcinoma of the left breast and underwent lumpectomy.
Patient underwent upper endoscopy and colonoscopy for evaluation. Upper endoscopy showed firm, nodular mucosa in the gastric body and the incisura that was biopsied. Colonoscopy showed several sub-centimeter polyps that were removed. Biopsies of nodular stomach mucosa and polyps showed carcinoma. Morphologically the tumor resembled breast tumor tissue. Immunohistochemical stain for GATA-3, a nuclear marker expressed in 94% of breast cancer tumors,3 was positive and CDX2, a marker suggestive of gastrointestinal origin, was negative. The morphologic appearance and immunohistochemical stain both supported diagnosis of breast cancer metastases.
Discussion: Because of its rarity and nonspecific clinical presentation and radiologic findings, clinicians must have high suspicion for metastases to the gastrointestinal tract in patients with history of breast cancer. The correct diagnosis may have an impact on patient's treatment regiment and prognosis.
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2. Uygun K, Kocak Z, Altaner S, Cicin I, Tokatli F, Uzal C. Colonic metastasis from carcinoma of the breast that mimics a primary intestinal cancer. Yonsei Med J. 2006;47(4):578-582. doi:10.3349/ymj.2006.47.4.578
3. Liu H, Shi J, Wilkerson ML, Lin F. Immunohistochemical evaluation of GATA3 expression in tumors and normal tissues: a useful immunomarker for breast and urothelial carcinomas. Am J Clin Pathol. 2012 Jul;138(1):57-64. doi: 10.1309/AJCP5UAFMSA9ZQBZ. PMID: 22706858.
Figure: Figure 1a: EGD showing firm nodular, mucosa. FIgure 1b: Gastric biopsy showing metastatic carcinoma. Figure 1c: Colonoscopy showing numerous sub-centimeter polypoid mucosa. Figure 1d: Colon polyp histology showing metastatic carcinoma. Figure 1e: Immunohistochemical staining for GATA-3 was positive suggestive of breast carcinoma as primary.
Disclosures: Vimal Bodiwala indicated no relevant financial relationships. Akhtar Cheema indicated no relevant financial relationships. Elliot Bigajer indicated no relevant financial relationships.
Vimal Bodiwala, MD1, Akhtar Cheema, MD2, Elliot Bigajer, DO2. P1258 - Breast Cancer Metastases to the Gastrointestinal Tract: A Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
