Abstract
Gastric cancer is a disease of elderly patients and mainly metastasis to liver, lung, and peritoneum, while signet ring cell is a variant of gastric cancer and commonly metastasis to peritoneum and lymph nodes. Metastasis to mammary is a rare condition which account for 3% and has poor prognosis. Generally extra mammary carcinoma precedes breast metastasis by 2 years. It’s uncommon to have breast metastasis as a first manifestation of extra mammary malignancies. There is no age limit and presentation my mimic primary breast cancer. Due to rarity of this condition there are no consensuses about clinical, radiological and histological features which make it a challenging task to distinguish primary from metastatic breast neoplasm. The case bellow is a young woman with diagnoses of diffuse-signet ring cell gastric cancer. First presentation was right breast edema with ascites, peritoneal nodules, and enlarged enhancing ovaries on imaging. Biopsy from each site confirmed involvement by metastatic adenocarcinoma with signet ring pattern. Her condition progressed after 5th cycle of EOX.
Highlights
Gastric cancer at young ages is rare
Carcinoma of stomach can spread by local extension, hematogenous spread, lymphatic dissemination or seeding of peritoneal surface, wide spread metastasis may involve any organ, especially liver, lung and peritoneum [6,8,9], while signet ring cell subtype’s main metastatic sites are peritoneum and lymph nodes rather than liver [10]
Breast cancer accounts for the most common malignancies, but metastasis to breast from extra mammary malignancies is a rare condition and comprising around 3% of breast malignancies, the majority are from contralateral breast, less than 0.5% resulted from extra mammary sites [14]
Summary
Gastric cancer at young ages is rare. The median age at diagnosis is 71 years and is the second most common cause of death worldwide [1]. Nidhamalddin et al / Breast cancer metastasis from Gastric Carcinoma in a young female. Gastroenteroscopy was performed, bleeding ulcers was seen over great curvature from mid body till antrum (Figure 4), histopathology of gastric lesion reported poorly differentiated adenocarcinoma diffuse signet ring type (Figure 5), IHC results was positive for AE1/AE3 and negative HER2 status. With collaboration of our oncologist, pathologist, radiologist we diagnosed and managed our case as signet ring cell gastric cancer, and she was started on EOX (EPIrubicin 50mg/m2, OXALIplatin 130mg/m2, Capecitabin 625mg/m2), on fifth cycle there was progression on image study, and we lost her after 2 weeks
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