S3625 Invasive Lobular Carcinoma of the Breast With Gastric Metastases

Abstract

Introduction: Gastric metastasis from breast cancer is a rare phenomenon with an incidence rate of approximately 0.3% per a previous review. It is important to be able to distinguish primary gastric carcinoma from metastasis of other primary malignancies which are infrequently known to metastasize to the stomach. Initial presentations vary and are non-specific – dyspepsia, dysphagia and hematemesis should raise suspicion in the correct clinical context. We present a case of a patient with a prior history of invasive lobular carcinoma status post lumpectomy and radiation therapy 3 years prior undergoing esophagogastroduodenoscopy revealing gastric metastasis from invasive lobular carcinoma. Case Description/Methods: 82-year-old female with a history of decompensated liver cirrhosis secondary to non-alcoholic steatohepatitis, invasive lobular carcinoma of the left breast status post lumpectomy and radiation therapy 3 years prior presented to the emergency department with worsening dysphagia to liquids and abdominal pain with distension. Pertinent labs revealed alkaline phosphatase of 308, AST 132, ALT 63, total bilirubin of 1.1, albumin 2.7 and creatinine of 2.6 (baseline of 1.2). Ultrasound of abdomen demonstrated cirrhosis with large amount of perihepatic ascites. EGD was performed revealing diffuse gastritis with a few gastric erosions. The antral area of the stomach was notable for the mucosa taking on a thickening of the folds particularly in the prepyloric antrum. This area was biopsied. A 4mm sessile gastric polyp along the lateral wall/greater curvature of the body of the stomach was identified and biopsied. The duodenum had normal appearing mucosa. Biopsy results of the gastric polyp and thickened antral folds were consistent with metastatic lobular carcinoma of the breast which were CK7 and GATA3 positive by immunohistochemistry. The tumor was found to be ER+, PR-, HER2-0. Discussion: Breast cancer is the most common malignancy in women in the United States with the exception of skin cancer. Invasive lobular carcinoma commonly metastasizes to bone, lung and liver. Although gastric metastasis of invasive breast cancer is relatively rare, non-specific gastrointestinal symptoms in any patient with a prior history of breast cancer should raise suspicion. Gastroenterologists should be mindful of subtle changes in mucosal appearance during endoscopic evaluation and consider a biopsy of the area of concern to rule out metastatic breast cancer (Figure).Figure 1.: Gastric polyp Figure 1B: Thickened antral folds Figure 1C: Antral fold biopsy demonstrating CK7 positivity Figure 1D: Antral fold biopsy demonstrating GATA3 positivity.