Abstract
IntroductionInvasive lobular carcinomas have an increased propensity for distant metastases, particularly to the peritoneum, ovaries, and uterus. In contrast, distant metastases of nonpalpable lobular carcinomas are extremely rare, and the causes of underlying symptoms of primary carcinomas remain unclear. We report a case of an asymptomatic invasive lobular carcinoma with a primary mammary lesion in a patient with rectal stenosis.Case presentationA 69-year-old Japanese woman presented to our hospital for treatment of constipation. Although rectal stenosis was confirmed, thorough testing of her lower digestive tract did not identify its cause. Thus, an exploratory laparotomy and tissue biopsy was performed, and the presence of an invasive lobular carcinoma was confirmed. Subsequent breast examinations showed that the invasive lobular carcinoma that led to the rectal stenosis was a metastatic lesion from a primary lesion of the breast duct. As the present breast lobular carcinoma was asymptomatic and nonpalpable, we did not initially consider metastatic breast cancer as a cause of her symptoms, and the final diagnosis was delayed.ConclusionsPeritoneal metastasis from nonpalpable invasive lobular carcinomas is very rare. However, breast cancer metastasis should be considered when carcinomatous peritonitis is present in a patient with an unknown primary cancer.
Highlights
Invasive lobular carcinomas have an increased propensity for distant metastases, to the peritoneum, ovaries, and uterus
Breast cancer metastasis should be considered when carcinomatous peritonitis is present in a patient with an unknown primary cancer
Asymptomatic, nonpalpable invasive lobular carcinoma from a primary breast lesion was discovered, following assessments of the symptoms caused by rectal stenosis
Summary
Compared with invasive ductal carcinomas, invasive lobular carcinomas have an increased propensity for distant metastases, in the peritoneum, ovaries, and uterus [1,2,3,4]. Asymptomatic, nonpalpable invasive lobular carcinoma from a primary breast lesion was discovered, following assessments of the symptoms caused by rectal stenosis. Case presentation A 69-year-old Japanese woman with unremarkable personal and family medical histories presented to the general surgery department of our hospital with constipation for approximately one month Her rectal examination revealed rectal stenosis and possible rectal cancer. The final diagnosis was of rectal stenosis caused by carcinomatous peritonitis arising from a metastatic invasive lobular breast cancer. After her diagnosis, courses of hormone therapy and taxane- and anthracycline-based drugs were administered. The disease gradually progressed and she died four years after the initial diagnosis
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