Gastrointestinal Tract Metastasis Research Articles

Rectal metastasis arising from breast cancer: a case report.

Breast cancer is the most common cancer among women worldwide. Breast cancer often metastasizes to the regional lymph nodes, bone, brain, liver, and lungs, whereas gastrointestinal tract metastases are rare. Herein, we present a rare case of rectal metastasis from breast cancer that occurred during palliative chemotherapy. A 69-year-old female with a history of invasive ductal carcinoma, negative for hormonal receptors and positive for human epidermal growth factor receptor 2 (HER2) receptor, underwent various treatments, including neoadjuvant chemotherapy, breast-conserving surgery, and adjuvant therapy. Eight months postoperatively, the patient experienced axillary lymph node recurrence, requiring palliative chemotherapy. Despite ongoing treatment, metastatic lesions were confirmed in the lungs and pleura. During palliative chemotherapy, the patient developed anal pain, and subsequent examination revealed an infiltrating rectal lesion. Despite histological confirmation of metastatic breast carcinoma and tubular adenoma, a multidisciplinary decision was made regarding palliative chemotherapy over surgical intervention. Eribulin was administered, but due to the patient's inability to tolerate the treatment, she passed away 3 months after rectal lesion diagnosis. Although breast cancer metastasis to the rectum is rare, clinicians should consider the possibility of rectal involvement and perform a digital rectal examination if anal symptoms are present.

Gastric metastasis and peritoneal carcinosis revealing primary breast cancer: an unusual presentation.

Breast cancer is the most frequent cancer among women. Gastrointestinal tract metastases are uncommon and might be misidentified as primary carcinoma.A noteworthy case-study involved 53-year-old-woman complaining from epigastric pain, ascites and overall health decline. Initial investigations were inconclusive, prompting laparoscopic peritoneal biopsies which revealed independent cell proliferation. Subsequently, a second look upper digestive endoscopy showed multiple gastric ulcerations suggestive of gastric carcinoma. Histologic examination confirmed independent cell proliferation with estrogen receptors expression, a characteristic feature of breast carcinoma. Further investigations led to bilateral invasive lobular breast carcinoma diagnosis. Epirubicin cycophosphamide was prescribed after progression under letrozole ribocilib therapy.This case aims to raise awareness among clinicians about the importance of ruling out breast cancer in patients with peritoneal carcinosis and paying attention to digestive symptoms in breast cancer patients with careful gastric endoscopic examination to avoid misdiagnosis.

Abstract 1639: Human immune system mouse model of ER+ metastatic breast cancer

Abstract In a recent clinical trial in heavily pretreated estrogen receptor alpha-positive (ER+) metastatic breast cancer (MBC), ~23% of patients reached the primary endpoint of clinical benefit of >24 weeks on Fulvestrant plus the anti-androgen Enzalutamide. ESR1 mutant biopsies had more T regulatory cells (t test p<0.021) and macrophages (p<0.003) than ESR1 wild type (WT), which had more TP53 mutations and higher levels of cytotoxic T effector cells (p<0.01). In addition, PD-L1 increased in post- vs. pre-treatment biopsies (paired t test p<0.002). This increase in PD-L1 post-treatment warrants testing if the addition of a checkpoint inhibitor to the Fulvestrant-Enzalutamide combination will enhance therapy efficacy in ER+ MBC resistant to standard endocrine therapy. However, the lack of immune competent ER+ breast cancer pre-clinical models is a major barrier to these studies. Human immune system (HIS) mouse models were developed as a platform in which to test immune checkpoint inhibitors in other human cancers, and one HIS model was recently shown to support the growth and immune infiltration of ER+ patient-derived xenograft (PDX) primary tumors. We tested whether HIS mice are a robust model in which to define ER+ tumor-immune microenvironment interactions at metastatic sites. We implanted NCG mice (NOD-Prkdcem26Cd52Il2rgem26Cd22/NjuCrl) humanized by engraftment of human umbilical cord blood-derived CD34+ (huCD34+) stem cells with the estrogen-independent HCI-013EI (013EI) PDX, derived from an ER+, invasive lobular MBC which harbors the Y537S ESR1 mutation. Mice were monitored for tumor latency and growth rate, and primary tumors and organs were collected for immunohistochemistry, single-cell RNA sequencing (scRNAseq), and phasor-fluorescence lifetime imaging microscopy (FLIM). The ER mutated PDX 013EI had a longer tumor latency in HIS (median 77 days) vs. age-matched immune deficient control mice (27.5 days, log-rank p=0.043). Once formed, 013EI tumors in HIS mice grew slower than those in controls (mixed-effects analysis, p=0.035). HIS mice had visible lung, liver, and/or gastrointestinal tract metastases despite small primary tumors. Lung metastases from HIS mice retain ER expression and are infiltrated by human CD4+, CD8+, and CD68+ immune cells. Initial scRNAseq analysis also suggests infiltration by diverse immune cell populations in primary tumors from HIS mice. Initial phasor-FLIM for NADH autofluorescence suggests that 013EI tumors are highly glycolytic in HIS mice. In conclusion, our results show that huCD34+ HIS mice effectively support growth, metastasis, and immune infiltration of an ESR1 mutant MBC PDX. Ongoing studies will further define the tumor-immune microenvironment in this and ESR1 WT MBC PDX, focusing on immune cell infiltration, PD-L1 expression, steroid receptor status, metabolic signaling and changes in these parameters following novel combinations of endocrine, immunotherapy and metabolic agents. Citation Format: Ayodeji Olukoya, Shaymaa Bahnassy, Nicole S. Spoelstra, Lu Jin, Suman Ranjit, Anthony Elias, Jennifer K. Richer, Rebecca B. Riggins. Human immune system mouse model of ER+ metastatic breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1639.

Metastatic Malignant Melanoma to Colon from Cutaneous Melanoma: A Case Report

Metastatic melanoma to the Gastrointestinal (GI) tract is rare and the colon is a less common site of GI tract metastasis for this cancer. We report a case of a 76-year-old male with history of cutaneous malignant melanoma since 2018 and two years later he developed metastasizing to the brain, axillary lymph node and descending colon. He was treated with stereotactic radiosurgery (SRS) for single brain metastasis, he subsequently underwent a combined left axillary node dissection and left colectomy. Importance of long-term surveillance and role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) and colonoscopy are discussed along with the role of surgical resection in improving survival. Nevertheless, metastatic malignant melanoma to the colon is difficult to identify diagnosis and treatment, multidisciplinary team discussion is necessary to determine the most appropriate treatment strategy.

Metastatic Malignant Melanoma to Colon from Cutaneous Melanoma: A Case Report

Metastatic melanoma to the Gastrointestinal (GI) tract is rare and the colon is a less common site of GI tract metastasis for this cancer. We report a case of a 76-year-old male with history of cutaneous malignant melanoma since 2018 and two years later he developed metastasizing to the brain, axillary lymph node and descending colon. He was treated with stereotactic radiosurgery (SRS) for single brain metastasis, he subsequently underwent a combined left axillary node dissection and left colectomy. Importance of long-term surveillance and role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) and colonoscopy are discussed along with the role of surgical resection in improving survival. Nevertheless, metastatic malignant melanoma to the colon is difficult to identify diagnosis and treatment, multidisciplinary team discussion is necessary to determine the most appropriate treatment strategy.

Immune escape mechanism behind resistance to anti-PD-1 therapy in gastrointestinal tract metastasis in malignant melanoma patients with multiple metastases.

Immunotherapy targeting the PD-1 axis has recently become a standard treatment for patients with malignant melanoma. However, approximately 25% of reported malignant melanoma patients who initially responded to immunotherapy with anti-PD-1 mAb had progressive disease, and the immune escape mechanism behind resistance to anti-PD-1 therapy is not yet fully understood in the clinical setting. In the present study, we included four malignant melanoma patients, in whom multiple metastases other than gastrointestinal tract metastasis had disappeared or were controlled under multidisciplinary treatment that included anti-PD-1 therapy. Using IHC, we evaluated the immune status of surgically resected specimens of gastrointestinal tract metastases as acquired resistant lesion to anti-PD-1 therapy. We herein report that the down-regulated expression of HLA class I and up-regulated expression of inhibitory immune checkpoint ligands, CD155 (ligand for T cell immunoglobulin and ITIM domain, TIGIT) and carcinoembryonic antigen-related adhesion molecule-1 (ligand for TIM-3), were observed on the tumor cells in the metastatic gastrointestinal tract tumors. Moreover, our results also suggest that stromal TGF-β may be related to this down-regulation of HLA class I expression on the tumor cells. In conclusion, it is likely that the down-regulated expression of HLA class I and additional expression of inhibitory immune checkpoint ligands other than PD-L1 on the tumor cells were acquired in the gastrointestinal tract metastasis during anti-PD-1 therapy in the malignant melanoma patients.

Caecal Metastasis: An Exceptional Manifestation Mode Revealing Small Cell Lung Carcinoma: Clinical Case and Review of the Literature

Lung carcinoma is the leading cause of death worldwide. Almost 50% of patients present with distant metastasis at the moment of diagnosis. The most common metastasis sites are the lymph nodes, the liver, the adrenal glands, the bones, and the brain. However, Gastro-Intestinal Tract (GIT) metastasis from primary lung carcinoma is a rare phenomenon and it is considered a late stage of the disease, generally detected in patients with a documented previous history of a primary lung malignancy. However, the finding of a lung cancer initially manifesting with GI-tract involvement is extremely rare and it is usually reported in the literature in isolated case reports. This case study involves a 70 year-old-man, initially presenting with digestive symptoms related to caecal metastasis from primary lung carcinoma.

Gastrointestinal tract metastasis of lung cancer: The PD-L1 expression and correlated clinicopathological variables.

The gastrointestinal tract is a rare site for metastatic lung cancer. Programmed cell death-ligand 1 (PD-L1) expression in lung cancer is a biomarker for the response to anti-PD-1/PD-L1 therapy. We investigated clinicopathological features and PD-L1 expression in 25 gastrointestinal metastatic tumors from the lung and primary adenocarcinoma of the small bowel. The small bowel was the most common site (16/25; 64%) of gastrointestinal tract lung cancer metastasis. A total of 19 (76%) of the gastrointestinal metastasis showed PD-L1 expression in ≥5% of tumor cells, with 14 (56%) showing high expression levels (≥50%). In contrast, 21 (84%) expressed PD-L1 in ≥5% immune cells, including 4 (16%) showing a high expression levels (≥50%). The PD-L1 expression on tumor cells and immune cells in primary lung cancer and corresponding gastrointestinal metastasis was concordant in 13 (68%) and 11 (58%) of the 19 paired cases, respectively. Small-bowel metastasis of lung cancer was characterized by a higher incidence of perforation (31% vs. 0%), ulcerated mass (83% vs. 60%), and neoplastic PD-L1 expression (75% vs. 0%) compared to primary small-bowel adenocarcinoma. Gastrointestinal metastasis from lung cancer might be a potential target for immune checkpoint inhibitor therapy, given its high expression of PD-L1.

S2777 Metastatic Cervical Adenocarcinoma: A Rare Cause of Upper GI Bleeding

INTRODUCTION: Primary small bowel neoplasms are rare, accounting for 1–5% of all gastrointestinal (GI) tract malignancies. Metastatic small bowel lesions are more common than primary and typically arise from malignant melanoma and adenocarcinomas from the lung, kidney and colon. Distant metastasis from cervical adenocarcinoma is extremely rare, most often seen with advanced stages. We report the case of a young female with known cervical cancer presenting with acute abdominal pain and melena secondary to metastatic ulcerated duodenal mass. CASE DESCRIPTION/METHODS: 43-year-old female with stage IIIB cervical adenocarcinoma status post pelvic radiation, human immunodeficiency virus (HIV) on antiretroviral therapy, and right upper extremity deep vein thrombosis on Eliquis presented with mild diffuse abdominal pain and intermittent melena over four weeks. On admission, she was afebrile and hemodynamically stable. Laboratory findings were significant for acute blood loss anemia with hemoglobin 3.3 g/dL (7.6 g/dL two months prior). Computed tomography abdomen and pelvis showed a heterogenous cervical mass near the sigmoid colon without signs of obstruction or perforation. Three units of packed red blood cells were transfused, proton pump inhibitor drip was initiated, and anticoagulation was held. Esophagogastroduodenoscopy revealed a large, infiltrative, ulcerated and friable mass within the second portion of the duodenum (Figure 1), occupying 50% of the luminal circumference with stigmata of recent bleeding. Duodenal mass biopsies confirmed metastatic cervical adenocarcinoma (Figures 2 and 3). She had no further bleeding throughout her course and was discharged home with palliative oncology care. DISCUSSION: Cervical cancer is the second most common gynecologic malignancy. Up to half of stage III cervical cancer patients present with distant metastases, most often to liver, lungs and bone marrow; however, only approximately 8% have GI tract metastases, often to the rectosigmoid secondary to local extension. Isolated metastases to the small bowel are exceedingly rare. Clinical presentations include small bowel obstruction, anemia, abdominal pain and, less commonly, overt GI bleeding. Early diagnosis of such an unusual pattern of metastasis related to cervical cancer is vital for optimal therapeutic management and prediction of prognosis.Figure 1.: Ulcerated mass at second portion of the duodenum.Figure 2.: Medium-power view demonstrating reactive duodenal mucosa on the top and poorly-differentiated carcinoma growing up from the submucosa (H&E, 100x).Figure 3.: High-power view demonstrating marked pleomorphism, 'bubbly' cytoplasm, apoptotic bodies and numerous atypical mitotic figures (H&E, 400x).

S1753 Breast Metastasis to the Colon: A Rare Case Report

INTRODUCTION: Metastatic disease occurs in 30% of breast cancer patients, with the most common sites of metastasis being lymph node, lung, liver, bone, or brain. Uncommonly, breast carcinoma metastasizes to the gastrointestinal tract. This report describes a rare case of a 48-year-old female with metastatic infiltrating ductal carcinoma to the colon. CASE DESCRIPTION/METHODS: A 48-year-old female presented with chronic diarrhea and abdominal pain, and no reported history of melena or hematochezia. Laboratory results were negative for celiac and C. difficile, and abdominal CT was concerning for colitis. Colonoscopy was performed and the transverse colon was noted to be strictured and inflamed. Colonic biopsies demonstrated malignant poorly differentiated cells expanding the lamina propria, with an intact and non-dysplastic colonic epithelial surface. Immunohistochemistry demonstrated positivity for CK7, rare mammaglobin, BRST-2, and GATA3, compatible with breast origin. An E-cadherin immunohistochemical stain showed retained strong membranous staining, indicative of a ductal phenotype. A diagnosis of metastatic poorly differentiated adenocarcinoma compatible with breast origin was made. Review of the clinical history revealed the patient to have had an infiltrating ductal carcinoma of the breast eight years prior and is now status post left mastectomy with adjuvant Tamoxifen. DISCUSSION: Breast metastasis to the gastrointestinal tract is uncommon, occurring in approximately 4–18% of metastatic breast cancer patients. Further, metastatic breast carcinoma to the colon is rare, estimated to occur in 3% of cases. Previously reported cases of gastrointestinal tract metastasis have predominantly been infiltrating lobular carcinoma. Infiltrating ductal carcinoma is known to metastasize to the lung, liver and bone, and there are few documented cases of metastasis to the colon. This reported case represents a rare finding of an infiltrating ductal breast carcinoma to the colon eight years after the initial diagnosis, diagnosed after colonoscopy and histopathological investigation. Breast metastasis to the gastrointestinal tract may present with vague signs and symptoms such as abdominal pain and changes in stool. Although rare, colonic metastasis should be considered in patients with a history of breast cancer who present with abdominal symptoms as early diagnosis will have a survival benefit.Figure 1.: Colonoscopy images of the transverse colon, demonstrating narrow lumen and inflammation.Figure 2.: (A-B) H&E. (C) BRST-2. (D) CK7 positive. (E) Mammaglobin, focally positive. (F) E-cadherin. (G) GATA-3 positive in the nuclei of many carcinoma cells. (H) CK20. (I) CDX2.

A giant malignant phyllodes tumor of breast post mastectomy with metastasis to stomach manifesting as anemia: a case report and review of literature

BackgroundPhyllodes tumors (PTs) are well known for local recurrence and progression. Less than 10% of these tumors grow larger than 10 cm. Distant metastases have been reported in up to 22% of malignant PTs, with most metastases being discovered in the lungs. PTs of the breast rarely metastasize to the gastrointestinal tract, and reported cases are scarce. To date, a review of the English literature revealed only 3 cases, including our case, of PTs metastasis to stomach.Case presentationAn 82-year-old female patient had 10-year-duration of palpable huge tumor on left breast which was in rapid growth in recent months. Total mastectomy of left breast was performed thereafter, and pathology diagnosis was malignant phyllodes tumor. Adjuvant radiotherapy was suggested while she declined out of personal reasons initially. For PTs recurred locally on left chest wall 2 months later, and excision of the recurrent PTs was performed. She, at length, completed adjuvant radiation therapy since then. Six months later, she was diagnosed of metastasis to stomach due to severe anemia with symptom of melena. Gastrostomy with tumor excision was performed for uncontrollable tumor bleeding.ConclusionFor PTs presenting as anemia without known etiologies, further studies are suggested to rule out possible gastrointestinal tract metastasis though such cases are extremely rare. Management of metastatic gastric tumor from PTs should be done on a case-to-case basis, surgical intervention may be needed if there is persistent active bleeding despite medical treatment. Adjuvant radiotherapy is recommended in borderline and malignant PTs with tumor-free margin < 1 cm and high-risk malignant tumors. Adjuvant chemotherapy or target therapy may be helpful for metastatic PTs. Molecular and genomic techniques may predict clinical outcomes of benign and borderline PTs more precisely.

AB180. Caught off guard—a case study of rare pathology “malignant melanoma”

Background: Malignant melanoma is an uncommon cause of gastrointestinal tract metastasis, despites views to the contrary. It’s presentation frequently differs from other causes of colonic cancers as patients are generally well preceding the event are often not anticipated. Most often, they are diagnosed during an autopsy. Only 0.2% to 9% of all malignant melanoma will have gastro intestinal gastrointestinal (GI) tract involvement. This case report describes a 49-year-old lady, diagnosed with this rare pathology.

Colonic Metastases from a Luminal A Type Invasive Ductal Carcinoma Breast: A Rare Case Report

AbstractMetastatic carcinoma breast involving hepatobiliary system and peritoneum is a common and well-described entity. However, colonic luminal involvement by breast metastases is rare and its early recognition is important for accurate management planning. We report a case of an elderly woman with luminal A type invasive ductal carcinoma (IDC) breast, initially controlled/stabilized on hormonal treatment and later progressed to involve colon presenting with intestinal obstructive symptoms. Lobular carcinoma breast which constitutes around 10% of breast cancers is more likely to have gastrointestinal tract (GIT) involvement. On the other hand, GIT metastasis from IDC breast is quite rare. Given the progressively increasing survival with current and forthcoming novel treatment modalities, it is very important to recognize and understand unusual presentation of metastatic breast cancer, such as colonic metastasis, for timely treatment planning and implementation.

Grade III meningioma with gastro-intestinal tract and brain metastases: case report and review of the literature

BackgroundMeningioma is the most common adult primary intracranial tumor. Malignant meningioma is a rare variant of meningioma. The prognosis for the patients with these tumors is poor, due to the tumor’s capacity for relapse and to develop distant metastases. These tumors can present the same evolutionary course as aggressive carcinoma.Case descriptionWe report the case of distant brain and gastro-intestinal tract (GIT) metastases. A 78-year-old patient developed malignant meningioma with a Ki-67 proliferative index of 40%. According to guidelines, surgery followed by postoperative radiotherapy (RT) was performed. Three months after the end of RT, he presented histologically proven meningioma distant brain and GIT metastases.ConclusionsTo our knowledge, this is the first case of meningioma GIT metastases. Also, we report the difficulty to confirm the diagnosis of meningioma metastases. Indeed, malignant meningioma has the same histopathological features as melanoma or carcinoma. The standard of care for the management of malignant meningioma is gross total surgery followed by postoperative radiotherapy. Metastatic meningioma is uncommon and no guidelines for the management of recurrent or metastatic meningioma have yet been published. However, several studies reported systemic therapeutic options such as antibody against VEGF, somatostatin analogs, PDGF-R, and VEGF-R tyrosine kinase inhibitors, in the case of recurrent or metastatic meningioma. We also made a review of the actual literature of systemic treatment options for metastatic meningioma.

Cystic gastric metastasis from pancreatic cancer

Gastrointestinal tract metastasis from pancreatic cancer is quite rare. We present the case of a 58-year-old male patient who underwent distal pancreatectomy for pancreatic body cancer 5 years prior. Four years after the initial operation, a 15-mm cystic submucosal tumor was found in the antrum of the stomach. Because the tumor had grown to 25 mm and the level of carcinoembryonic antigen in the cystic fluid derived by ultrasound-guided fine-needle aspiration biopsy was high, partial resection of the stomach was performed 5 years after the distal pancreatectomy. Pathological diagnosis was gastric metastasis of pancreatic cancer. The patient has been alive without recurrence for 13 months after the resection of the cystic tumor. We are not aware of any similar cases of cystic gastric metastasis from pancreatic cancer published in the English literature.

An Unusual Cause of Obscure Gastrointestinal Bleeding

Question: A 54-year-old man was referred to our hospital with a 1-month history of intermittent tarry to bloody stool. His medical history included hepatitis B–related liver cirrhosis and hepatocellular carcinoma (HCC). His hepatoma was diagnosed 1 year earlier (American Joint Committee on Cancer Staging T3aN0M0) , and he was treated with radiofrequency ablation and tumor embolization. The tumor recently progressed with portal vein tumor thrombosis (Figure A). He underwent sorafenib therapy; however, the drug was discontinued after the bleeding episode. Examination with upper endoscopy and colonoscopy failed to identify the cause of bleeding. Despite medical therapy, including a proton pump inhibitor and octreotide, the bleeding persisted, and he was referred to our hospital for deep enteroscopy. The laboratory examination revealed anemia (hemoglobin 9.1 g/dL), thrombocytopenia (platelet count, 131 × 109/L), and a normal prothrombin time. The calculated Model for End-stage Liver Disease score was 8 and the Child-Pugh class was B. Deep enteroscopy via the anal route was performed, and a lesion at 100 cm from the ileocecal valve was found (Figure B, Video Clip A). What are the findings of enteroscopy? What is the differential diagnosis? Look on page 361 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI. Enteroscopy revealed a bleeding submucosal tumor in the ileum (Figure B). Hemostasis via enteroscopy failed, and a submucosal tattoo was placed around the lesion. Review of the computed tomography examination revealed a previously unrecognized tumor in the ileum (Figure C, arrow). To control the bleeding, the patient decided to undergo laparoscopic tumor resection (Figure D). Pathologic examination revealed a 2.5-cm ulcerative tumor involving the whole layer of the small intestine with pleomorphic nuclei, coarse chromatin, prominent nucleoli, and abundant eosinophilic cytoplasm (Figure E) with positive staining for Hep-par-1 (Figure F). Metastatic HCC was diagnosed. After surgery, the bleeding was controlled, but the patient died of progressive liver failure after 6 weeks. HCC is the most common liver malignancy. Distant metastases from HCC usually involve the lung, regional lymph nodes, bone, or adrenal glands, and only 0.2% of metastatic HCC involve the gastrointestinal tract.1Chen L.T. Chen C.Y. Jan C.M. et al.Gastrointestinal tract involvement in hepatocellular carcinoma: clinical, radiological and endoscopic studies.Endoscopy. 1990; 22: 118-123Crossref PubMed Scopus (79) Google Scholar The mechanisms of gastrointestinal tract metastasis are direct invasion (82%), hematogenous metastasis (9%), and seeding (9%), and most cases are discovered at autopsy.2Yang C.W. Soon M.S. Chen Y.Y. et al.Synchronous metastasis to the oral cavity and proximal upper small intestine as an initial presentation of hepatocellular carcinoma: report of a case.Gastroenterol J Taiwan. 2009; : 318-320Google Scholar The present case was considered to have hematogenous spread because of portal vein tumor thrombus and no peritoneal dissemination or direct invasion. Endoscopic findings of gastrointestinal metastases from HCC included raised and centrally ulcerated lesions, polypoid tumors, and submucosal tumors.1Chen L.T. Chen C.Y. Jan C.M. et al.Gastrointestinal tract involvement in hepatocellular carcinoma: clinical, radiological and endoscopic studies.Endoscopy. 1990; 22: 118-123Crossref PubMed Scopus (79) Google Scholar, 2Yang C.W. Soon M.S. Chen Y.Y. et al.Synchronous metastasis to the oral cavity and proximal upper small intestine as an initial presentation of hepatocellular carcinoma: report of a case.Gastroenterol J Taiwan. 2009; : 318-320Google Scholar The treatment of HCC with gastrointestinal tract metastases comprises palliative care, minimally invasive surgery, or rarely, endoscopic resection.3Igawa A. Oka S. Tanaka S. et al.Small bowel metastasis of hepatocellular carcinoma detected by capsule endoscopy.Case Rep Gastroenterol. 2013; 7: 492-497Crossref PubMed Scopus (7) Google Scholar The prognosis is usually ominous with a median overall survival of 5 months, because gastrointestinal involvement is often a sign of advanced disease.2Yang C.W. Soon M.S. Chen Y.Y. et al.Synchronous metastasis to the oral cavity and proximal upper small intestine as an initial presentation of hepatocellular carcinoma: report of a case.Gastroenterol J Taiwan. 2009; : 318-320Google Scholar eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJhMjYxNTVkZmZkYjU3NjRkYjlmMTAxZDc2NGRiZTZjZSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc5MDkzMTYzfQ.gdjzK2Nf51DgpOUxpyDVFJgvcc-1uFMg1xcGldDxkDRwgr2AgdFYgTWngJGS61kOUBpAhf3qRuJTNYKkDx9DkX4KQX1FYq5EUoWWRg4oFhL_VIZvDHAXfAtczZVEO_TVyrmguX12SRZFCnTd0_pMze0DJqL08Z_k3nG51b3-46KHlBbts1qKZhr-VGQc7NgQHuv82BEymLbZfKXCY2KT83UqeigxGVTnA9ZsR7pTF9-VSZXsRoEVxSEaITBsmO-1YUJK7065Zj4cFT4h5GgN9m3Zj7MSdf5DnK9DdvdxU-qhqGXXrhz11BUGr9XjiEo7YXaHKNQJ-q6s_jVcGsTqJA Download .mp4 (63.22 MB) Help with .mp4 files Video Clip

Distinct Pattern of Metastases in Patients with Invasive Lobular Carcinoma of the Breast.

Invasive lobular carcinoma (ILC) comprises around 10 - 15% of invasive breast cancers. Few prior studies have demonstrated a unique pattern of metastases between ILC and the more common invasive ductal carcinoma (IDC). To our knowledge, such data is limited to first sites of distant recurrence. We aimed to perform a comparison of the metastatic pattern of ILC and IDC at first distant recurrence as well as over the entire course of metastatic disease. We used a prospectively collated database of patients with metastatic breast cancer. Breast cancer recurrence or metastases were classified into various sites and a descriptive analysis was performed. Among 761 patients, 88 (11.6%) were diagnosed with ILC and 673 (88.4%) with IDC. Patients with ILC showed more frequent metastases to the bone (56.8 vs. 37.7%, p = 0.001) and gastrointestinal (GI) tract (5.7 vs. 0.3%, p < 0.001) as first site of distant recurrence, and less to organs such as lung (5.7 vs. 24.2%, p < 0.001) and liver (4.6 vs. 11.4%, p = 0.049). Over the entire course of metastatic disease, more patients with ILC had ovarian (5.7 vs. 2.1%, p = 0.042) and GI tract metastases (8.0 vs. 0.6%, p < 0.001), also demonstrating reduced tendency to metastasize to the liver (20.5 vs. 49.0%, p < 0.001) and lung (23.9 vs. 51.9%, p < 0.001). All associations but bone held after sensitivity analysis on hormonal status. Although patients presenting with ILC were noted to have more advanced stage at presentation, recurrence-free survival in these patients was increased (4.8 years vs. 3.2 years, p = 0.017). However, overall survival was not (2.5 vs. 2.0 years, p = 0.75). After accounting for hormone receptor status, patients with IDC had greater lung/pleura and liver involvement, while patients with ILC had a greater propensity to develop ovarian and GI metastases both at first site and overall. Clinicians can use this information to provide more directed screening for metastases; it also adds to the argument that these two variants of breast cancer should be managed as unique diseases.

Breast cancer metastases to the stomach and colon mimicking primary gastrointestinal cancer: Four cases and literature review

Intraluminal gastric and colonic metastases of the breast cancer are very rare and may sometimes prove a diagnostic dilemma to distinguish from primary gastric and colonic cancers. It is important to make the distinction in order to navigate the proper treatment approach, which is a systemic treatment rather than surgery if the disease is me- tastatic. The spread to the gastrointestinal (GI) tract is more frequent in lobular histology and according to a number of investigators, it is related to a particular tropism of lobular cells toward gastrointestinal mucosa. Any region of GI tract may be involved, from the tongue to the anus. Over the last decade, among the 1,100 breast cancer cases registered at our institutions, we diagnosed four patients with breast cancer who had metastases to the stomach and/or colon and presented symptoms that simulated primary gastrointestinal cancer. A total of 84 out of the 1,100 patients experienced invasive lobular histology. Among the four patients with GI tract metastases, three were diagnosed with lobular hist- ology – two of whom had the signet ring cell subtype. The remaining patient was diagnosed with triple negative invasive ductal carcinoma; however, it clinically resembled invasive lobular carcinoma. Clinical and pathological features of these cases, as well as the review of related literature are discussed in this report.

Metastases of malignant melanoma to stomach.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kuzu U, Suna N, Gokcan H, Abdullazade S, Öztas E, Odemis B. Metastases of malignant melanoma to stomach. Gastroenterology Review/Przegląd Gastroenterologiczny. 2016;11(1):54-55. doi:10.5114/pg.2016.57755. APA Kuzu, U., Suna, N., Gokcan, H., Abdullazade, S., Öztas, E., & Odemis, B. (2016). Metastases of malignant melanoma to stomach. Gastroenterology Review/Przegląd Gastroenterologiczny, 11(1), 54-55. https://doi.org/10.5114/pg.2016.57755 Chicago Kuzu, Ufuk Barıs, Nuretdin Suna, Hale Gokcan, Samir Abdullazade, Erkin Öztas, and Bulent Odemis. 2016. "Metastases of malignant melanoma to stomach". Gastroenterology Review/Przegląd Gastroenterologiczny 11 (1): 54-55. doi:10.5114/pg.2016.57755. Harvard Kuzu, U., Suna, N., Gokcan, H., Abdullazade, S., Öztas, E., and Odemis, B. (2016). Metastases of malignant melanoma to stomach. Gastroenterology Review/Przegląd Gastroenterologiczny, 11(1), pp.54-55. https://doi.org/10.5114/pg.2016.57755 MLA Kuzu, Ufuk Barıs et al. "Metastases of malignant melanoma to stomach." Gastroenterology Review/Przegląd Gastroenterologiczny, vol. 11, no. 1, 2016, pp. 54-55. doi:10.5114/pg.2016.57755. Vancouver Kuzu U, Suna N, Gokcan H, Abdullazade S, Öztas E, Odemis B. Metastases of malignant melanoma to stomach. Gastroenterology Review/Przegląd Gastroenterologiczny. 2016;11(1):54-55. doi:10.5114/pg.2016.57755.

The value of SATB2 in the differential diagnosis of intestinal-type mucinous tumors of the ovary: primary vs metastatic.

Primary mucinous adenocarcinomas of the ovary are a diagnostic challenge because their histologic and immunohistochemical features usually overlap with metastatic tumors. SATB2 is a recently identified protein with restricted expression in the glandular cells lining the lower gastrointestinal tract. The aim of this study is to examine the differential expression of SATB2 in primary and metastatic tumors of the ovary. Mucinous ovarian tumors of intestinal type were retrieved from the pathology files of the Instituto Nacional de Cancerología de México. A double reading of the hematoxylin and eosin-stained slides was performed to confirm the diagnosis, and a detailed review of the clinical chart was performed to define the primary origin of the tumor (ovarian vs metastatic). Immunohistochemical staining for CK20, CDX2, and SATB2 was performed and evaluated by 2 gynecopathologists. A total of 106 mucinous tumors were identified, 26 of which were considered to be metastatic, and 80 of which were primary ovarian tumors. All of the primary tumors that were not associated with cystic teratomas were negative for SATB2, and the 4 that were associated with a teratoma were positive for SATB2. All 20 of the metastatic tumors of the colon and appendix were positive for CK20, and 4 were positive for CK7. In addition, all 20 of these tumors were positive for SATB2, and 19 were positive for CDX2. SATB2 appears to be a useful marker for the diagnosis of primary vs metastatic mucinous intestinal-type neoplasms and is highly sensitive in detecting lower gastrointestinal tract metastasis.