Purpose: We report a rare case of a patient who presented with obstructive jaundice from a pancreatic tumor metastasizing from breast cancer and gastrointestinal bleeding secondary to esophageal and gastric metastasis. Gastrointestinal tract metastasis from primary breast carcinoma is present in 14% to 35% of cases in autopsy series, with gastric involvement in 6% to 18% of cases. Management of these metastasis differs from the management of conventional primary cancers. Methods: Chart review and review of available literature using Medline and relevant bibliographies of published articles. Results: A 52-year-old woman presented with complaints of melena, painless jaundice and fatigue. Her past medical history included a modified radical mastectomy three years ago for invasive ductal carcinoma. Physical examination was remarkable for pallor and scleral icterus. Laboratory work-up was consistent with anemia and marked elevation in total bilirubin (19.3 mg/dl) and alkaline phosphatase (2933 U/L). Abdominal and pelvic CT scanning (with oral and intravenous contrast) showed dilated intrahepatic and extrahepatic bile ducts and a rounded soft tissue mass in the head of the pancreas. Esophagogastroduodenoscopy (EGD) was performed which revealed a 4 mm non-bleeding lesion in the distal esophagus and a 1 cm bleeding lesion at the cardia which was treated with endoscopic therapy and esomeprazole. Biopsies were obtained from the esophageal and gastric lesions. Endoscopic retrograde cholangiopancreatography (ERCP) with contrast medium showed a diffusely dilated biliary tree. A sphincterotomy was performed, brush cytology obtained and a stent was placed in the common bile duct. Immunohistochemical analysis of the biopsy specimens tested positive for cytokeratin 7 and ERBB-2. Further immunostaining of the original breast tumor specimen was consistent with the same immunophenotype. Conclusion: As the prognosis of cancer patients has been improving gradually, gastrointestinal metastasis will be encountered more often. The goals of therapy (i.e., cure, palliation, quality of life) should be clear in each case and survival expectancy from the primary disease and associated conditions estimated.Figure: Immunohistochemical staining of gastric lesion