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Case Report Open Access

Gastric wall thickening and gastric outlet obstruction due to peritoneal metastasis in breast cancer: A case report

  • Authors:
    • Bin He
    • Lin Ling Li
    • Ting Yu
    • Yu Tan
    • Ling Zhang
  • View Affiliations / Copyright

    Affiliations: School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China, Department of Pathology, The General Hospital of Western Theater Command of the Chinese People's Liberation Army, Chengdu, Sichuan 610083, P.R. China, Department of Oncology, The General Hospital of Western Theater Command of the Chinese People's Liberation Army, Chengdu, Sichuan 610083, P.R. China
    Copyright: © He et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 86
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    Published online on: January 29, 2026
       https://doi.org/10.3892/etm.2026.13081
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Abstract

Peritoneal metastasis from breast cancer is rare and diagnostically challenging. This challenge is particularly compounded in patients receiving CDK4/6 inhibitors, as their characteristic gastrointestinal adverse effects can mimic the symptoms of peritoneal carcinomatosis. A woman with hormone receptor‑positive/HER2‑negative metastatic breast cancer developed symptoms of functional gastric outlet obstruction (manifesting as delayed gastric emptying) 2 months after initiating palbociclib treatment. Imaging revealed diffuse and marked gastric wall thickening. Initial gastroscopic biopsies were non‑diagnostic, but laparotomy confirmed peritoneal carcinomatosis, with histology and immunohistochemistry confirming metastatic breast cancer. The present case underscores the diagnostic difficulty in differentiating drug toxicity from disease progression in patients on CDK4/6 inhibitors. The key clinical messages are: i) Persistent gastrointestinal symptoms despite CDK4/6 inhibitor withdrawal warrant investigation for peritoneal metastasis; ii) serosal‑based metastases have the potential to cause notable gastric wall thickening and functional gastric outlet obstruction while sparing the mucosa, potentially evading initial endoscopic diagnosis; and iii) a multifactorial pathogenesis involving structural infiltration and neuro‑myogenic dysfunction is proposed to underlie this clinical presentation.
View Figures

Figure 1

Timeline of the clinical course of
the patient, outlining the key events, including initial diagnosis,
multidisciplinary treatments, recurrence, development of abdominal
symptoms, diagnostic workup and outcome. IDC, invasive ductal
carcinoma; BSO, bilateral salpingo-oophorectomy; AC-T, Adriamycin
cyclophosphamide-taxol.

Figure 2

Contrast-enhanced abdominal CT
findings at initial presentation with abdominal symptoms. (A) Axial
CT image demonstrates marked gastric distension with intragastric
fluid retention, consistent with gastrostasis. (B) Coronal CT image
shows circumferential wall thickening extending from the gastric
antrum to the pylorus (arrow), with heterogeneous attenuation; the
maximum wall thickness is ~16.05 mm. (C) Additional axial CT image
again demonstrates marked gastric distension and fluid retention,
consistent with pyloric obstruction and gastrostasis.

Figure 3

Gastroscopic and corresponding
histopathological findings. (A) Gastroscopy of the gastric body
demonstrates edematous and nodular mucosa with luminal narrowing;
the mucosa was friable upon contact. (B) Gastroscopy of the gastric
antrum reveals prominent nodular, edematous mucosa with marked
luminal narrowing. (C) Additional gastroscopic view of the gastric
antrum shows diffusely nodular and edematous mucosa with persistent
luminal narrowing. (D) Photomicrograph of a biopsy specimen from
the gastric body (H&E stain; magnification, x100) shows chronic
superficial gastritis without evidence of malignant cells.

Figure 4

Follow-up contrast-enhanced CT
imaging revealing disease progression. (A) Axial CT image shows
diffuse and irregular gastric wall thickening with heterogeneous
enhancement. (B) Coronal CT image demonstrates progressive, diffuse
and irregular wall thickening extending from the gastric
fundus/body to the pyloric region, with heterogeneous enhancement.
(C) Axial CT image reveals a newly enlarged nodule within the
hepatogastric ligament, highly suggestive of metastatic
involvement.

Figure 5

Histopathological examination of
surgical specimens from the exploratory laparotomy.
Photomicrographs (H&E stain; magnification, x100) show
infiltrating poorly differentiated adenocarcinoma involving
different sites. (A) Intestinal wall, revealing atypical cells with
eosinophilic cytoplasm infiltrating the fibrous and smooth muscle
stroma. (B) Gastric wall, showing infiltration of atypical cells
with eosinophilic cytoplasm within the fibrous stroma and adjacent
to small vessels. (C) Gastric antrum, deeper sectioning of the
initial gastroscopic biopsy specimen revealed occasional atypical
cells with eosinophilic cytoplasm at the edge of the submucosa. (D)
Strong nuclear positivity for GATA binding protein 3
(immunohistochemistry; magnification, x100) in the tumor cells from
the gastric antral lesion.

Figure 6

Histopathological and IHC findings of
the omental biopsy. (A) Photomicrograph (H&E stain;
magnification, x100) shows infiltration of poorly differentiated
adenocarcinoma composed of atypical cells with eosinophilic
cytoplasm within the fibroadipose tissue. IHC staining
(magnification, x100) demonstrates strong positivity for (B)
estrogen receptor (80%), (C) GATA binding protein 3, (D) gross
cystic disease fluid protein 15, (E) CK7 and (F) CK8/18. (G-L) The
tumor cells are negative for (G) CK20, (H) CK5/6, (I) p63, (J)
thyroid transcription factor 1, (K) Villin and (L) Wilms tumor 1.
This immunoprofile confirms metastatic breast carcinoma. Scale
bars, 100 µm. IHC, immunohistochemical; CK, cytokeratin.

Figure 7

Diagnostic and therapeutic workflow
based on the CARE guidelines guidelines. The algorithm outlines the
patient's journey from initial assessment and primary treatment
through follow-up, recurrence, key decision points and outcomes.
IHC, immunohistochemical; ER, estrogen receptor; PR, progesterone
receptor; EC, epirubicin and cyclophosphamide.

Figure 8

Proposed mechanism of gastric wall
thickening and functional gastric outlet obstruction in peritoneal
metastasis from breast cancer. Schematic diagrams illustrate six
key pathophysiological processes: (A) Serosal and lymphatic
infiltration causing edema; (B) Aberrant angiogenesis and vascular
leakage; (C) Transmural tumor invasion with desmoplasia; (D)
Autonomic nerve involvement leading to gastroparesis; (E) Injury to
interstitial cells of Cajal resulting in dysmotility; and (F)
Tumor-associated inflammation contributing to edema and impaired
motility. ICC, interstitial cells of Cajal.
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Copy and paste a formatted citation
Spandidos Publications style
He B, Li LL, Yu T, Tan Y and Zhang L: Gastric wall thickening and gastric outlet obstruction due to peritoneal metastasis in breast cancer: A case report. Exp Ther Med 31: 86, 2026.
APA
He, B., Li, L.L., Yu, T., Tan, Y., & Zhang, L. (2026). Gastric wall thickening and gastric outlet obstruction due to peritoneal metastasis in breast cancer: A case report. Experimental and Therapeutic Medicine, 31, 86. https://doi.org/10.3892/etm.2026.13081
MLA
He, B., Li, L. L., Yu, T., Tan, Y., Zhang, L."Gastric wall thickening and gastric outlet obstruction due to peritoneal metastasis in breast cancer: A case report". Experimental and Therapeutic Medicine 31.4 (2026): 86.
Chicago
He, B., Li, L. L., Yu, T., Tan, Y., Zhang, L."Gastric wall thickening and gastric outlet obstruction due to peritoneal metastasis in breast cancer: A case report". Experimental and Therapeutic Medicine 31, no. 4 (2026): 86. https://doi.org/10.3892/etm.2026.13081
Copy and paste a formatted citation
x
Spandidos Publications style
He B, Li LL, Yu T, Tan Y and Zhang L: Gastric wall thickening and gastric outlet obstruction due to peritoneal metastasis in breast cancer: A case report. Exp Ther Med 31: 86, 2026.
APA
He, B., Li, L.L., Yu, T., Tan, Y., & Zhang, L. (2026). Gastric wall thickening and gastric outlet obstruction due to peritoneal metastasis in breast cancer: A case report. Experimental and Therapeutic Medicine, 31, 86. https://doi.org/10.3892/etm.2026.13081
MLA
He, B., Li, L. L., Yu, T., Tan, Y., Zhang, L."Gastric wall thickening and gastric outlet obstruction due to peritoneal metastasis in breast cancer: A case report". Experimental and Therapeutic Medicine 31.4 (2026): 86.
Chicago
He, B., Li, L. L., Yu, T., Tan, Y., Zhang, L."Gastric wall thickening and gastric outlet obstruction due to peritoneal metastasis in breast cancer: A case report". Experimental and Therapeutic Medicine 31, no. 4 (2026): 86. https://doi.org/10.3892/etm.2026.13081
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