Asymptomatic solitary metastasis to the stomach from breast cancer: A case report

Kaneko,Yuki; Koi,Yumiko; Kajitani,Keiko; Ohara,Masahiro; Daimaru,Yutaka

doi:10.3892/mco.2020.2145

Asymptomatic solitary metastasis to the stomach from breast cancer: A case report

Authors:
- Yuki Kaneko
- Yumiko Koi
- Keiko Kajitani
- Masahiro Ohara
- Yutaka Daimaru
View Affiliations

Affiliations: Department of Breast Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738‑8503, Japan, Section of Pathological Research and Laboratory, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738‑8503, Japan
Published online on: September 23, 2020 https://doi.org/10.3892/mco.2020.2145
Article Number: 75
Copyright: © Kaneko et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Distant metastases from breast cancer are frequently found in bones, lungs and the liver. Metastasis to the stomach is rare, and its clinical presentation remains unclear. The present report describes a case of isolated gastric metastasis from breast cancer identified by contrast‑enhanced computed tomography (CT). A 45‑year‑old female patient underwent right mastectomy and axillary lymph node dissection after preoperative chemotherapy for right invasive lobular breast carcinoma T4bN2M0, stage IIIB. Postoperative radiotherapy and endocrine therapy with tamoxifen for 5 years were performed. CT for postoperative follow‑up at 52 years old revealed thickening of the stomach wall. Although the patient was asymptomatic, erosive mucosa was observed on the gastric body during gastroscopy. The gastric lesion was immunohistochemically diagnosed as metastatic luminal disease from the breast cancer. Positron emission tomography/CT revealed no abnormal accumulation suggesting metastasis to other organs. Palbociclib and fulvestrant treatment were initiated for gastric metastasis. Invasive lobular breast carcinoma results in gastrointestinal metastasis, including the stomach, more frequently than invasive ductal breast carcinoma. However, most gastric metastases occur simultaneously with systemic metastases. Solitary metastasis to the stomach without symptoms as in this case has rarely been reported. The possibility of gastric metastasis should be considered among the differential diagnoses, even in the absence of symptoms, when gastrointestinal abnormalities are seen on CT in patients with a history of breast cancer.

View Figures

View References

1	Torre LA, Islami F, Siegel RL, Ward EM and Jemal A: Global cancer in women: Burden and trends. Cancer Epidemiol Biomarkers Prev. 26:444–457. 2017.PubMed/NCBI View Article : Google Scholar
2	Arps DP, Healy P, Zhao L, Kleer CG and Pang JC: Invasive ductal carcinoma with lobular features: A comparison study to invasive ductal and invasive lobular carcinomas of the breast. Breast Cancer Res Treat. 138:719–726. 2013.PubMed/NCBI View Article : Google Scholar
3	Siegel RL, Fedewa SA, Miller KD, Goding-Sauer A, Pinheiro PS, Martinez-Tyson D and Jemal A: Cancer statistics for Hispanics/Latinos, 2015. CA Cancer J Clin. 65:457–480. 2015.PubMed/NCBI View Article : Google Scholar
4	McCart Reed AE, Kutasovic JR, Lakhani SR and Simpson PT: Invasive lobular carcinoma of the breast: Morphology, biomarkers and 'omics. Breast Cancer Res. 17(12)2015.PubMed/NCBI View Article : Google Scholar
5	Ferlicot S, Vincent-Salomon A, Médioni J, Genin P, Rosty C, Sigal-Zafrani B, Fréneaux P, Jouve M, Thiery JP and Sastre-Garau X: Wide metastatic spreading in infiltrating lobular carcinoma of the breast. Eur J Cancer. 40:336–341. 2004.PubMed/NCBI View Article : Google Scholar
6	Arpino G, Bardou VJ, Clark GM and Elledge RM: Infiltrating lobular carcinoma of the breast: Tumor characteristics and clinical outcome. Breast Cancer Res. 6:R149–R156. 2004.PubMed/NCBI View Article : Google Scholar
7	He H, Gonzalez A, Robinson E and Yang WT: Distant metastatic disease manifestations in infiltrating lobular carcinoma of the breast. AJR Am J Roentgenol. 202:1140–1148. 2014.PubMed/NCBI View Article : Google Scholar
8	McLemore EC, Pockaj BA, Reynolds C, Gray RJ, Hernandez JL, Grant CS and Donohue JH: Breast cancer: Presentation and intervention in women with gastrointestinal metastasis and carcinomatosis. Ann Surg Oncol. 12:886–894. 2005.PubMed/NCBI View Article : Google Scholar
9	Oda Kondo H, Yamao T, Saito D, Ono H, Gotoda T, Yamaguchi H, Yoshida S and Shimoda T: Metastatic tumors to the stomach: Analysis of 54 patients diagnosed at endoscopy and 347 autopsy cases. Endoscopy. 33:507–510. 2001.PubMed/NCBI View Article : Google Scholar
10	Taal BG, Peterse H and Boot H: Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma. Cancer. 89:2214–2221. 2000.PubMed/NCBI
11	Greene FL: Breast tumours. In: TNM classification of malignant tumours. Sobin LH, Gospodarowicz MK and Wittekind C (eds). 7th edition. Wiley-Blackwell, Oxford, pp181-193, 2009.
12	Korhonen T, Kuukasjärvi T, Huhtala H, Alarmo EL, Holli K, Kallioniemi A and Pylkkänen L: The impact of lobular and ductal breast cancer histology on the metastatic behavior and long term survival of breast cancer patients. Breast. 22:1119–1124. 2013.PubMed/NCBI View Article : Google Scholar
13	Christgen M and Derksen P: Lobular breast cancer: Molecular basis, mouse and cellular models. Breast Cancer Res. 17(16)2015.PubMed/NCBI View Article : Google Scholar
14	de Groot JS, Ratze MA, van Amersfoort M, Eisemann T, Vlug EJ, Niklaas MT, Chin SF, Caldas C, van Diest PJ, Jonkers J, et al: αE-catenin is a candidate tumor suppressor for the development of E-cadherin-expressing lobular-type breast cancer. J Pathol. 245:456–467. 2018.PubMed/NCBI View Article : Google Scholar
15	Rakha EA, Patel A, Powe DG, Benhasouna A, Green AR, Lambros MB, Reis-Filho JS and Ellis IO: Clinical and biological significance of E-cadherin protein expression in invasive lobular carcinoma of the breast. Am J Surg Pathol. 34:1472–1479. 2010.PubMed/NCBI View Article : Google Scholar
16	Berx G, Cleton-Jansen AM, Nollet F, de Leeuw WJ, van de Vijver M, Cornelisse C and van Roy F: E-cadherin is a tumour/invasion suppressor gene mutated in human lobular breast cancers. EMBO J. 14:6107–6115. 1995.PubMed/NCBI
17	Schwarz RE, Klimstra DS and Turnbull AD: Metastatic breast cancer masquerading as gastrointestinal primary. Am J Gastroenterol. 93:111–114. 1998.PubMed/NCBI View Article : Google Scholar
18	Ushida Y, Yoshimizu S, Horiuchi Y, Yoshio T, Ishiyama A, Hirasawa T, Tsuchida T and Fujisaki J: Clinicopathological features of metastatic gastric tumors originating from breast cancer: Analysis of eleven cases. World J Oncol. 9:104–109. 2018.PubMed/NCBI View Article : Google Scholar
19	Pectasides D, Psyrri A, Pliarchopoulou K, Floros T, Papaxoinis G, Skondra M, Papatsibas G, Macheras A, Athanasas G, Arapantoni-Datioti P and Economopoulos T: Gastric metastases originating from breast cancer: Report of 8 cases and review of the literature. Anticancer Res. 29:4759–4763. 2009.PubMed/NCBI
20	Kim GH, Ahn JY, Jung HY, Park YS, Kim MJ, Choi KD, Lee JH, Choi KS, Kim DH, Lim H, et al: Clinical and endoscopic features of metastatic tumors in the stomach. Gut Liver. 9:615–622. 2015.PubMed/NCBI View Article : Google Scholar
21	D'Angelo F, Rampini A, Cardella S, Antolino L, Nigri G, Valabrega S, Aurello P and Ramacciato P: Breast cancer metastasis to the stomach. J Cancer Metastasis Treat. 5(30)2019.
22	Insko EK, Levine MS, Birnbaum BA and Jacobs JE: Benign and malignant lesions of the stomach: Evaluation of CT criteria for differentiation. Radiology. 228:166–171. 2003.PubMed/NCBI View Article : Google Scholar
23	Shimada H, Okazumi S, Koyama M and Murakami K: Japanese gastric cancer association task force for research promotion: Clinical utility of 18F-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature. Gastric Cancer. 14:13–21. 2011.PubMed/NCBI View Article : Google Scholar
24	Yun M: Imaging of gastric cancer metabolism using 18 F-FDG PET/CT. J Gastric Cancer. 14:1–6. 2014.PubMed/NCBI View Article : Google Scholar
25	Pera M, Riera E, Lopez R, Vinolas N, Romagosa C and Miquel R: Metastatic carcinoma of the breast resembling early gastric carcinoma. Mayo Clin Proc. 76:205–207. 2001.PubMed/NCBI View Article : Google Scholar
26	Eo WK: Breast cancer metastasis to the stomach resembling early gastric cancer. Cancer Res Treat. 40:207–210. 2008.PubMed/NCBI View Article : Google Scholar
27	O'Connell FP, Wang HH and Odze RD: Utility of immunohistochemistry in distinguishing primary adenocarcinomas from metastatic breast carcinomas in the gastrointestinal tract. Arch Pathol Lab Med. 129:338–347. 2005.PubMed/NCBI View Article : Google Scholar
28	van Velthuysen ML, Taal BG, van der Hoeven JJ and Peterse JL: Expression of oestrogen receptor and loss of E-cadherin are diagnostic for gastric metastasis of breast carcinoma. Histopathology. 46:153–157. 2005.PubMed/NCBI View Article : Google Scholar
29	Koike K, Kitahara K, Higaki M, Urata M, Yamazaki F and Noshiro H: Clinicopathological features of gastric metastasis from breast cancer in three cases. Breast Cancer. 21:629–634. 2014.PubMed/NCBI View Article : Google Scholar
30	Viacava P, Naccarato AG and Bevilacqua G: Spectrum of GCDFP-15 expression in human fetal and adult normal tissues. Virchows Arch. 432:255–260. 1998.PubMed/NCBI View Article : Google Scholar
31	Mazoujian G, Bodian C, Haagensen DE Jr and Haagensen CD: Expression of GCDFP-15 in breast carcinomas. Relationship to pathologic and clinical factors. Cancer. 63:2156–2161. 1989.PubMed/NCBI View Article : Google Scholar
32	Gown AM, Fulton RS and Kandalaft PL: Markers of metastatic carcinoma of breast origin. Histopathology. 68:86–95. 2016.PubMed/NCBI View Article : Google Scholar