Breast cancer is the most frequently diagnosed life-threatening cancer in women and the leading cause of cancer death among women . The most common first site of distant spread for breast cancer was bone (51%), followed by lung (17%), brain (16%), and liver (6%). The remaining 10% of patients had multiple metastatic sites. A case report done in 2011 by Aliasger A Amin et al , showed metastasis of lobular carcinoma to the rectum . Read on to find out more details on the case !
Rectal metastasis from breast cancer: an interval of 17 years
Summary
Metastasis to gastrointestinal (GI) tract from breast cancer is rare. Commonly affected organ in GI tract is stomach, followed by colon and then rectum. The authors report a case of a 61-year-old woman who had a mastectomy for lobular carcinoma of the breast 17 years ago and was referred to colorectal clinic with increased frequency of stools. Colonoscopy showed a stricture in the rectum, but biopsy was inconclusive. As she was symptomatic, she had a Hartmann’s resection 5 months after she initially presented to the clinic. Histopathology of the resected specimen showed it to be metastasis from lobular carcinoma of the breast. Awareness of potential long delays in the presentation of metastatic breast cancer especially lobular carcinoma helps in the earlier diagnosis and clinical management.
Background
Metastasis to gastrointestinal (GI) tract from breast cancer is rare. Awareness of potential delays in the presentation of metastatic breast cancer especially lobular carcinoma helps in the earlier diagnosis and clinical management.
Case presentation
A 61-year-old woman presented to the clinic with a 3-month history of change in bowel habits, that is, loose stools (6–20 times/day) and faecal urgency following a holiday. There was no history of bleeding, mucous discharge per rectum or associated bowel symptoms. Her medical history included recurrent deep venous thrombosis (life long warfarin) and a right-sided mastectomy 17 years ago for lobular breast cancer with negative axillary lymph nodes and had tamoxifen for 5 years. Colonoscopy showed a circumferential smooth stricturing lesion in the rectum (10 cm from anal verge). Biopsy results from this abnormal area were inconclusive. She was diagnosed as possible gastroenteritis/colitis and was managed conservatively. CT and MR scan showed mucosal thickening involving the whole rectum, with preservation of mural structures, showing no suggestions of malignancy. She became gradually more symptomatic with the stricture in the rectum, and went on to have a Hartmann’s resection (delay of 5 months).
Investigations
Histopathology of the resected specimen showed it to be a metastatic lobular carcinoma from the breast. On immunohistochemical staining, the tumour cells were negative for cytokeratin (CK) 20 but showed strong and diffuse positive staining for oestrogen receptor and CK7 and weak patchy staining for progesterone receptor. This immunoprofile was in keeping with metastatic lobular carcinoma of breast. She went on to have a staging CT scan which showed at least two metastatic lymph nodes in the axillary region. Core biopsy of the axillary lymph node confirmed malignancy.
 |
| Histology slide showing normalrectal mucosa and breast cancer |
Treatment
She had a right-sided axillary node clearance. Nodes were oestrogen receptor positive but negative for HER 2. She had adjuvant letrozole.
Learning points
▶ Carcinoma of the breast has a potential to metastasize to gastrointestinal tract, more commonly, lobular carcinoma of the breast.
▶ Metastasis to the gastrointestinal tract from breast cancer can occur many years after the initial primary.
▶ We should be aware that presenting symptoms of a metastatic breast cancer to the rectum can be non-specific and difficult to diagnose even on endoscopic biopsy.
▶ A thorough approach is required to diagnose a rectal metastasis from a breast carcinoma in the form of radiological studies, endoscopy and biopsy.
▶ It is important to be aware of such an occurrence and a high degree of suspicion is required; since early diagnosis can enable us to start systemic therapy before a complication sets in, avoiding unnecessary surgery and improving outcome.
References/ Sources :
0 comments:
Post a Comment