Abstract
Breast cancer is the most common cancer in women; it is well-known to metastasize to lymph nodes, lungs, liver, brain, and bones. However, luminal gastrointestinal metastasis is rare, especially to the appendix. Herein, we report a case where cancer metastasized to the ileum and appendix, causing acute appendicitis and small bowel obstruction. This is a 44-year-old female with a history of stage IV metastatic breast cancer to bones, lungs, and ovaries, presented with acute abdominal pain for one day. Her abdomen was soft, distended with generalized tenderness. Computed tomography (CT) of the abdomen and pelvis showed a partial small bowel obstruction and swollen appendix. After her symptoms worsened on conservative treatment, she was taken to the operating room where she was found to have a markedly dilated ileum with signs of acute appendicitis, so she underwent ileocecectomy, appendectomy, and lysis of adhesions. Pathology showed metastatic breast cancer in the appendix with findings consistent with acute appendicitis. She tolerated surgery well without complications. In conclusion, small intestinal and appendiceal metastases of breast cancer are very rare though they should be considered in the differential diagnosis in cancer patients presenting with acute abdominal pain.
Highlights
Breast cancer is currently the most common type of malignancy [1], with an observed incidence rate of 127.5 per 100, 000 women per year according to the Surveillance, Epidemiology and End Results (SEER) program [2]
We present the case of a 44-year-old lady with estrogen receptor (ER) and progesterone receptor (PR) positive, human epidermal growth factor receptor 2 (HER-2) negative metastatic breast cancer (MBC) who was evaluated for abdominal pain and subsequently diagnosed with acute appendicitis secondary to appendiceal metastases
Metastatic patterns of breast carcinoma have been studied, suggesting two important factors that impact the site of tumor spread: the estrogen receptor (ER) status and the pathology of cancer [6]
Summary
Breast cancer is currently the most common type of malignancy [1], with an observed incidence rate of 127.5 per 100, 000 women per year according to the Surveillance, Epidemiology and End Results (SEER) program [2]. Literature review reveals only 15 prior cases of metastatic breast cancer (MBC) with the involvement of the appendix, with most patients undergoing appendectomy [4,5]. Since this is a rare event, which may cause acute appendicitis and carries a high risk of perforation, early recognition, and appropriate management is crucial. Due to the severity of the pain, computed tomography (CT) of the abdomen and pelvis showed partial small bowel obstruction and a swollen appendix but did not meet the diagnostic criteria of acute appendicitis (Figures 1-2). Her postoperative course was uncomplicated, and she was discharged home with follow-up with surgery and oncology
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