A Rare Case of Metastatic Breast Carcinoma to the Stomach and the Colon

Abstract

Purpose: A 46 year old female presented to the emergency department after a routine lab draw revealed pancytopenia with hemoglobin of 5.4. She was complaining of chronic fatigue, left upper quadrant pain, and a palpable lump beneath her left breast. She had also noted unintentional weight loss over the past several months. She had previously received several blood transfusions for persistent microcytic anemia though the cause of her anemia had not been established. Previous attempts at colonoscopy and mammography were unsuccessful due to her morbid obesity. Her past medical history included IDDM, myocardial infarction, stroke, and hepatitis C. On exam the patient was afebrile with a heart rate of 91 and blood pressure of 122/71. In general she was a pale, morbidly obese female in no distress. Breast exam revealed a palpable mass in the lower quadrant of the left breast. Abdominal exam was significant for splenomegaly. Stool guaiac was positive. Laboratory exam revealed a WBC of 3.9, Hgb 5.7, HCT 17, and PLT 38,000. She was admitted for work-up of her pancytopenia and abdominal pain. A peripheral smear revealed marked normochromic normocytic anemia and thrombocytopenia. A CT scan was done to evaluate her abdominal pain and revealed hepatosplenomegaly and a mottled appearance of her pelvis and spine. Colonoscopy revealed 2 sessile polyps which were removed by cold biopsy polypectomy. EGD was done and multiple small polypoid lesions were noted along with cobblestoning of the gastric mucosa. Multiple biopsies were taken and histologic findings and results of immunohistochemical stains were consistent with primary breast cancer with metastasis to stomach and colon. Discussion: The true incidence of breast cancer metastatic to the gastrointestinal tract is not clear. Most instances of breast cancer metastatic to the GI tract have been reported as case reports with gastric or intestinal involvement. The combined upper and lower GI tract involvement is rare. In general, gastrointestinal metastases are reported to occur in 4-18% of patients with known disseminated breast cancer.Figure: A: Stomach nodules-EGD. B: Stomach pathology. C: Colon pathology.