Dyspepsia Due to Metastatic Breast Cancer

Abstract

Purpose: Introduction: Metastatic spread of breast cancer to the upper gastrointestinal tract has been infrequently reported in the literature (1). The common sites of spread include bones, lung and liver. We report a rare case of metastatic lobular breast cancer to stomach. Methods: Case: A 51 year-old African-american woman presented with complaints of dyspepsia and weight loss. She denied any melena, hematochezia or vomiting. Lab work revealed HB 7.6%; AST 129; ALT 125; Alk P 360; Direct/Total Bilirubin 1.3/2.5; Albumin/Protein 2.3/5.8; BUN/Creatinine 11/1.4; Amylase 102; Lipase 82; HAV and HBV immune and HCV negative. Contrast CT abdomen showed double duct sign with pancreatic head fullness, which were confirmed by MRCP. Bone scan revealed diffuse metastatic bone disease. Two years prior to this presentation, she underwent modified radical mastectomy with adjuvant chemotherapy and radiotherapy for Stage IIIa (ER/PR +ve HER 2 NEU −ve) invasive lobular carcinoma of the left breast. She subsequently was taking Tamoxifen and till recently remained symptom-free. Results: EUS during this presentation revealed 12 mm antral mass which was biopsied; pancreatic head fullness which unfortunately could not be sampled due to technical difficulties. Antral biopsy immunohistochemistry demonstrated staining for AE1/AE3; cytokeratin 7 +ve/ cytokeratin 20 −ve. This immunoprofile pattern confirmed a metastatic breast carcinoma. Conclusion: Discussion: Despite improvement in treatment of breast cancer, distant metastatic disease continues to occur. The incidence of breast cancer metastasis to the stomach, especially lobular cancer is higher then other variants including ductal cancers (2). A high index of suspicion for metastatic disease to the stomach of previous breast cancer should be maintained when new gastrointestinal symptoms develop. 1. Menuck LS, Amberg JR. Metastatic disease involving the stomach. Am J Dig Dis. 1975;20:903–13. 2. Taal BG, den Hartog Jager FC, Steinmetz R, Peterse H. The spectrum of gastrointestinal metastases of breast carcinoma, I: stomach. Gastrointest Endosc. 1992;38:130–135.Figure: H&E staining of metastatic breast carcinoma to stomach