C0712 - Gastric Outlet Obstruction Secondary to Metastatic Breast Carcinoma 25 Years After Initial Diagnosis: A Mimic of Primary Gastric Carcinoma

William Abel, MD, Shravani Reddy, MD, Brandon Ganjineh, , Vishal Golil, MD, Paul Yeaton, MD, Douglas Grider, MD
Virginia Tech Carilion School of Medicine, Roanoke, VA

Introduction: Breast cancer is the most common cancer in women with a yearly incidence rate of 43.1 per 100,000 women. While bone, lung, liver, and brain are the most common sites of distant metastasis, gastric metastasis is exceedingly rare, occurring in only 0.3% of cases. This case of breast carcinoma metastatic to the stomach occurred 25 years after initial diagnosis- a length of time not documented in the literature.

Case Description/Methods: A 71-year-old female with a history of breast cancer, diagnosed and treated 25 years prior (considered disease free), presented with nausea, vomiting and weight loss. Initial esophagogastroduodenoscopy (EGD) revealed gastric outlet obstruction with circumferential thickening at the antrum (Panel 1) and later endoscopic mucosal resection (EMR) was performed, but a definitive diagnosis was unable to be made from this specimen. Surgical specimen from Billroth II showed a poorly cohesive carcinoma involving all layers of the stomach with lymph node metastasis (Panel 2). The histopathology (Panel 3) ruled out gynecologic and intestinal malignancy and matched the previous profile from the patient’s previous breast cancer 25 years prior. No concurrent breast primary site was found on subsequent workup. Thus, a diagnosis of chronologically late metastatic breast cancer to the stomach was made.

Discussion: One of the challenges in evaluation of metastatic carcinoma to the stomach is obtaining an adequate biopsy of diagnostic quality. Given that the foci of metastases may be within the gastric wall or even confined to the subserosa or serosa, a surgical specimen may be required to obtain a sample of optimal quality. This was true in the case of our patient where even EMR specimen showed focal involvement and surgical resection was diagnostic. Since breast cancer accounts for over a quarter of cases of gastric metastatic cancer, it is important for both clinicians and pathologists to have a high level of suspicion since ancillary immunohistochemical studies are often required to make the diagnosis. Unique features of this case include absence of a concurrent breast lesion and long time to recurrence of 25 years. Literature review revealed this to be the longest time from diagnosis of primary breast cancer to distant metastasis in the stomach documented, illustrating the importance of not only a thorough history, but of clinical correlation for both pathologists and clinicians.



Disclosures:


William Abel, MD, Shravani Reddy, MD, Brandon Ganjineh, , Vishal Golil, MD, Paul Yeaton, MD, Douglas Grider, MD. C0712 - Gastric Outlet Obstruction Secondary to Metastatic Breast Carcinoma 25 Years After Initial Diagnosis: A Mimic of Primary Gastric Carcinoma, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.