Metastasis Of Breast Carcinoma Research Articles

Berberine inhibits breast carcinoma proliferation and metastasis under hypoxic microenvironment involving gut microbiota and endogenous metabolites

A potential role of berberine, a benzyl isoquinoline alkaloid, in cancer therapy is apparent. Its underlying mechanisms of berberine against breast carcinoma under hypoxia have not been elucidated. We focused on the doubt how berberine restrains breast carcinoma under hypoxia in vitro and in vivo. A molecular analysis of the microbiome via 16 S rDNA gene sequencing of DNA from mouse faeces confirmed that the abundances and diversity of gut microbiota were significantly altered in 4T1/Luc mice with higher survival rate following berberine treatment. A metabolome analysis liquid chromatography-mass spectrometer/mass spectrometer (LC-MS/MS) revealed that berberine regulated various endogenous metabolites, especially L-palmitoylcarnitine. Furthermore, the cytotoxicity of berberine was investigated in MDA-MB-231, MCF-7, and 4T1 cells. In vitro to simulate under hypoxic environment, MTT assay showed that berberine inhibited the proliferation of MDA-MB-231, MCF-7, and 4T1 cells with IC50 values of 4.14 ± 0.35 μM, 26.53 ± 3.12 μM and 11.62 ± 1.44 μM, respectively. Wound healing and trans-well invasion studies revealed that berberine inhibited the invasion and migration of breast cancer cells. RT-qPCR analysis shed light that berberine reduced the expression of hypoxia-inducible factor-1α (HIF-1α) gene. Immunofluorescence and western blot demonstrated that berberine decreased the expression of E-cadherin and HIF-1α protein. Taken together, these results provide evidence that berberine efficiently suppresses breast carcinoma growth and metastasis in a hypoxic microenvironment, highlighting the potential of berberine as a promising anti-neoplastic agent to combat breast carcinoma.

The Role of Tumor Microenvironment and Impact of Cancer Stem Cells on Breast Cancer Progression and Growth

Abstract Breast cancer is not only a mass of genetically abnormal tissue in the breast. This is a well-organized system of a complex heterogeneous tissue. Cancer cells produce regulatory signals that stimulate stromal cells to proliferate and migrate; then, stromal elements respond to these signals by releasing components necessary for tumor development that provide structural support, vasculature, and extracellular matrices. Developing tumors can mobilize a variety of cell types from both local and distant niches via secret chemical factors derived from cancer cells themselves or neighboring cells disrupted by growing neo-plasm, such as fibroblasts, immune inflammatory cells, and endothelial cells. CSCs are a group of very few cells that are tumorigenic (able to form tumors) and are defined as those cells within a tumor that can selfrenew and lead to tumorigenesis. BCSCs represent a small population of cells that have stem cell characteristics and are related to breast cancer. There are different theories about the origin of BCSCs. BCSCs are responsible for breast carcinoma metastasis. Usually, there is a metastatic spread to the bones, and rarely to the lungs and liver. A phenomenon that allows BCSCs to make the transition from epithelial to mesenchymal expression and thus avoid the effect of cyto toxic agents is the epithelial-mesenchymal transition (EMT). During this process, cells change their molecular characteristics in terms of loss of epithelial characteristics taking the mesenchymal phenotype. This process plays a key role in the progression, invasion, and metastasis of breast tumors.

Radiomics nomogram based on digital breast tomosynthesis: preoperative evaluation of axillary lymph node metastasis in breast carcinoma.

This study aimed to establish a radiomics nomogram model based on digital breast tomosynthesis (DBT) images, to predict the status of axillary lymph nodes (ALN) in patients with breast carcinoma. The data of 120 patients with confirmed breast carcinoma, including 49 cases with axillary lymph node metastasis (ALNM), were retrospectively analyzed in this study. The dataset was randomly divided into a training group consisting of 84 patients (37 with ALNM) and a validation group comprising 36 patients (12 with ALNM). Clinical information was collected for all cases, and radiomics features were extracted from DBT images. Feature selection was performed to develop the Radscore model. Univariate and multivariate logistic regression analysis were employed to identify independent risk factors for constructing both the clinical model and nomogram model. To evaluate the performance of these models, receiver operating characteristic (ROC) curve analysis, calibration curve, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discriminatory improvement (IDI) were conducted. The clinical model identified tumor margin and DBT_reported_LNM as independent risk factors, while the Radscore model was constructed using 9 selected radiomics features. Incorporating tumor margin, DBT_reported_LNM, and Radscore, the radiomics nomogram model exhibited superior performance with AUC values of 0.933 and 0.920 in both datasets, respectively. The NRI and IDI showed a significant improvement, suggesting that the Radscore may serve as a useful biomarker for predicting ALN status. The radiomics nomogram based on DBT demonstrated effective preoperative prediction performance for ALNM in patients with breast cancer.

Artificial Intelligence–Aided Diagnosis of Breast Cancer Lymph Node Metastasis on Histologic Slides in a Digital Workflow

Identifying lymph node (LN) metastasis in invasive breast carcinoma can be tedious and time-consuming. We investigated an artificial intelligence (AI) algorithm to detect LN metastasis by screening hematoxylin and eosin (H&E) slides in a clinical digital workflow. The study included 2 sentinel LN (SLN) cohorts (a validation cohort with 234 SLNs and a consensus cohort with 102 SLNs) and 1 nonsentinel LN cohort (258 LNs enriched with lobular carcinoma and postneoadjuvant therapy cases). All H&E slides were scanned into whole slide images in a clinical digital workflow, and whole slide images were automatically batch-analyzed using the Visiopharm Integrator System (VIS) metastasis AI algorithm. For the SLN validation cohort, the VIS metastasis AI algorithm detected all 46 metastases, including 19 macrometastases, 26 micrometastases, and 1 with isolated tumor cells with a sensitivity of 100%, specificity of 41.5%, positive predictive value of 29.5%, and negative predictive value (NPV) of 100%. The false positivity was caused by histiocytes (52.7%), crushed lymphocytes (18.2%), and others (29.1%), which were readily recognized during pathologists’ reviews. For the SLN consensus cohort, 3 pathologists examined all VIS AI annotated H&E slides and cytokeratin immunohistochemistry slides with similar average concordance rates (99% for both modalities). However, the average time consumed by pathologists using VIS AI annotated slides was significantly less than using immunohistochemistry slides (0.6 vs 1.0 minutes, P = .0377). For the nonsentinel LN cohort, the AI algorithm detected all 81 metastases, including 23 from lobular carcinoma and 31 from postneoadjuvant chemotherapy cases, with a sensitivity of 100%, specificity of 78.5%, positive predictive value of 68.1%, and NPV of 100%. The VIS AI algorithm showed perfect sensitivity and NPV in detecting LN metastasis and less time consumed, suggesting its potential utility as a screening modality in routine clinical digital pathology workflow to improve efficiency.

Nerve Root Metastasis of Breast Carcinoma Detected by Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan.

A 35-year-old woman with history of breast cancer was referred to our department for restaging by F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan. Aside from multiple other FDG-avid metastatic lesions, a segmental increased FDG uptake was visualized along the asymmetrically thicker left first sacral nerve root, highly concerning for metastatic disease, which was confirmed by the subsequently performed magnetic resonance imaging. Our case highlights the capability of FDG PET/CT scan in the correct diagnosis of the extremely rare phenomenon of nerve root metastasis as well as the importance of differentiating FDG-avid lumbosacral nerve roots from adjacent skeletal metastases.

Abstract P3-07-20: Treatment of 4T1 Breast Cancer with Liposome-Encapsulated AdAPT-001, a TGF-beta Trap Encoded Oncolytic Adenovirus Currently in a Phase 1/2 Anticancer Trial

Abstract Adenoviral vectors have been used extensively for gene therapy. However, efficient infection of cells requires expression of the coxsackie-adenoviral receptor (CAR). Many tumor cells lack adequate expression of CAR and, hence, are not good targets for adenoviral based vectors. We have developed a unique nanoparticle (Epi-039) that can be used to efficiently introduce adenoviral vectors into tumor cells that have low or no CAR expression. We used the CAR-negative 4T1 mammary carcinoma model system, which represents a typical triple-negative breast cancer cell line (ER−, PR−, HER2−) and which is refractory to adenoviral infection to demonstrate effective transduction of an encapsulated oncolytic adenovirus. The adenovirus that was used is called AdAPT-001. This armed oncolytic virus, which is currently in a phase I/II clinical trial called BETA PRIME for the treatment of refractory cancers, expresses a TGFb receptor trap to neutralize the immunosuppressive cytokine, TGF beta. Overexpression of TGF-beta positively correlates with metastasis in breast carcinoma and thus confers a poorer prognosis. In this study, the unique Epi-039 nanoparticle carrying AdAPT-001 not only significantly enhanced the transduction efficiency of AdAPT-001 but also protected it from neutralization by natural antibodies in human whole blood. Accordingly, we demonstrate a significant increase (P value= 0.0029) in the expression of green fluorescent protein (GFP) in CAR-negative 4T1 cells infected with the encapsulated AdAPT-001 adenovirus but not the unencapsulated AdAPT-001 adenovirus. Additional in vivo studies using nanoparticle encapsulated adenoviral vectors including AdAPT-001 to treat breast cancer are underway for rapid translation to the clinic. Citation Format: Tony Reid, Andrew Kummel, Scott Caroen, Jaimin Shah, Bryan Oronsky, Christopher Larson. Treatment of 4T1 Breast Cancer with Liposome-Encapsulated AdAPT-001, a TGF-beta Trap Encoded Oncolytic Adenovirus Currently in a Phase 1/2 Anticancer Trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-07-20.

Orbital Metastases of Breast Cancer in Males

We report a case of orbital metastasis of infiltrative breast carcinoma in a 65-year-old man. The patient was diagnosed with stage four breast cancer one year before, for which a mastectomy was performed. He refused postoperative radiotherapy and chemotherapy at that time. He had a history of lung, liver, and mediastinal metastases. At admission, he presented with blurred vision, diplopia, ocular pain, and mild swelling of the upper lid of the left eye (LE). Computed tomography (CT) of the brain and orbit revealed a front-ethmoidal tissue mass with left orbital and frontal intracranial extension. Ophthalmologic examination revealed exophthalmos on the LE with a downward and outward deviation of the eyeball, proptosis, and intraocular pressure (IOP) of 40 mmHg. The patient's treatment started with topical maximal anti-glaucomatous drops and radiotherapy sessions. After three weeks of follow-up, there was a gradual improvement of local symptoms and signs and a normal IOP.

Eltrombopag Inhibits Metastasis in Breast Carcinoma by Targeting HuR Protein

Eltrombopag is a small molecule TPO-R agonist that has been shown in our previous studies to inhibit tumor growth by targeting Human antigen R (HuR) protein. HuR protein not only regulates the mRNA stability of tumor growth-related genes, but it also regulates the mRNA stability of a variety of cancer metastasis-related genes, such as Snail, Cox-2, and Vegf-c. However, the role and mechanisms of eltrombopag in breast cancer metastasis have not been fully investigated. The purpose of this study was to investigate whether eltrombopag can inhibit breast cancer metastasis by targeting HuR. Our study first found that eltrombopag can destroy HuR-AU-rich element (ARE) complexes at the molecular level. Secondly, eltrombopag was found to suppress 4T1 cell migration and invasion and inhibit macrophage-mediated lymphangiogenesis at the cellular level. In addition, eltrombopag exerted inhibitory effects on lung and lymph node metastasis in animal tumor metastasis models. Finally, it was verified that eltrombopag inhibited the expressions of Snail, Cox-2, and Vegf-c in 4T1 cells and Vegf-c in RAW264.7 cells by targeting HuR. In conclusion, eltrombopag displayed antimetastatic activity in breast cancer in an HuR dependent manner, which may provide a novel application for eltrombopag, hinting at the multiple effects of HuR inhibitors in cancer therapy.

18F-FDG PET-CT in Cutaneous Metastases in Breast Carcinoma: An unusual presentation.

Cutaneous and subcutaneous metastases are an exceedingly rare presentation in various malignancies. These represent poor prognosis and disease progression. Early detection of such findings helps in changing the management plan. 18F-FDG PET-CT has played a key role in deciding treatment plan for patients with breast cancer, by detecting metastatic sites, with a high sensitivity in detecting cutaneous metastases as seen in the following case.

Comparison of GATA-3, Mammaglobin and GCDFP-15 Expression in Primary, Metastatic and Triple Negative Breast Carcinomas: An Indian Scenario.

Mammaglobin and GCDFP-15 are traditional immunohistochemistry (IHC) markers utilized to recognize metastasis of breast carcinoma in an unknown primary. GATA-3 is increasingly being used as a marker of primary breast origin. This study was done to evaluate and compare GATA-3 with GCDFP-15 and Mammaglobin in invasive primary including metastatic and triple negative breast carcinomas. Immunohistochemistry for GATA-3, GCDFP-15 and Mammaglobin was applied on 100 cases of primary breast carcinomas, including 20 triple negative cases and 30 cases of metastatic breast carcinomas. Staining scores were given for each marker by multiplying the percentage of positive tumor cells by the intensity of staining (1+, 2+ or 3+), with scores ranging from 0 to 300. Staining score of 1 or more was considered positive. GATA-3 was expressed in 92% of primary, 80% of metastatic and 60% of triple negative breast carcinomas, with an average staining score of 270. Mammaglobin was expressed in 68% of primary, 56.6% of metastatic and 25% of triple negative breast carcinomas, with an average staining score of 180. GCDFP-15 was expressed in 48% of primary, 26.6% of metastatic and 05% of breast carcinomas, with an average staining score of 60. GATA-3 demonstrated to have higher staining score (average of 270) than other two markers in maximum number of cases. GATA-3 has a higher sensitivity and increased staining scores in primary breast carcinomas, metastatic breast carcinomas as well as in triple negative breast carcinomas.

Contribution of Outpatient Ultrasound Transvaginal Biopsy and Puncture in the Diagnosis and Treatment of Pelvic Lesions: A Bicenter Study.

The use of transvaginal ultrasound guided biopsy and puncture of pelvic lesions is a minimally invasive technique that allows for accurate diagnosis. It has many advantages compared to other more invasive (lower complication rate) or non-invasive techniques (accurate diagnosis). Furthermore, it offers greater availability, it does not radiate, enables the study of pelvic masses accessible vaginally with ultrasound control in real time, and it is possible to use the colour Doppler avoiding puncturing large vessels among others. The main aim of the work is to describe a standardized ambulatory technique and to determine its usefulness. This is a retrospective study of ultrasound transvaginal punctures (core needle biopsies and cytologies) and drainages of pelvic lesions performed on an outpatient basis during the last two years. The punctures were made with local anesthesia, under transvaginal ultrasound guidance with an automatic or semi-automatic 18G biopsy needle with a length of 20-25 cm and a penetration depth of 12 or 22 mm. The material obtained was sent for anatomopathological, cytological and/or microbiological study if necessary. A total of 42 women were recruited in two centers. Fifty procedures (nine punctures, seven drains, and 34 biopsies) were performed. In five cases the punction and drain provided clinical relief in benign pelvic masses. Regarding material of the biopsies performed, 15 were vaginal in women previously histerectomized, finding 10 carcinomas, eight were ovarian tumours in advanced stages or peritoneal carcinomatosis obtaining the appropriate histology in each case, seven were suspicious cervical biopsies finding carcinomas in five of them, three were myometrial biopsies including one breast carcinoma metastasis in the miometrium and a benign placental nodule, and a periurethral biopsy was performed on a woman with a history of endometrial cancer confirming recurrence. The pathological diagnosis was satisfactory in all cases, confirming the nature of the lesion (25 malignant-ten vaginal recurrences of previous gynaecological cancers, eight cases of primary ovarian/peritoneal carcinoma, four new diagnosis of cervical malignant masses, one cervical metastasis of lymphoma, one periurethral recurrence of endometrial carcinoma and one recurrence of breast cancer in the myometrium-and 23 benign). The tolerance was excellent and no complications were detected. The ambulatory ultrasound transvaginal puncture and drainage technique is useful for obtaining a sample for pathological and microbiological diagnosis with excellent tolerance that can be used to rule out the recurrence of malignant lesions or progression of the disease, diagnose masses not accessible to gynecological exploration (vaginal vault, myometrium or cervix) and for early histologic diagnosis in cases of advanced peritoneal carcinomatosis or ovarian carcinoma as well as drainage and cytological study of cystic pelvic masses.

Carcinoma en cuirasse of breast presenting as keloidal structures

Abstract Carcinoma en cuirasse, also known as scirrhous carcinoma, is a form of cutaneous metastasis of breast carcinoma. The incidence of “en cuirasse” is approximately 0.6%–10% of cases. The most common sites for cutaneous metastases are the chest wall and abdomen. It is characterized by an erythematous, indurated plaque, nodules, or morphea-like plaques over the chest wall. We report a rare case of carcinoma en cuirasse of breast presenting as keloidal-like nodules in a 55-year-old woman.

Liver metastasis of breast carcinoma: An unusual presentation and growth pattern

Breast carcinoma is one of the tumors that frequently metastasize to the liver. Extramedullary hematopoiesis (EMH) usually occurs due to insufficient medullary hematopoiesis. In this case report, we present a female patient with sinusoidal breast carcinoma metastasis and extramedullary hematopoiesis in liver biopsy. A 63-year-old female patient with history of breast carcinoma was admitted to our center with respiratory distress. Pleural effusion was detected and thoracentesis was planned. Treatment was given after detection of non-mycobacterial tuberculosis bacillus in the thoracentesis fluid. Antibiotherapy was terminated due to elevation of liver enzymes and bilirubin. The patient's clinical status was evaluated and treatment was re-initiated. The patient did not have any mass lesion in the liver. Tru-cut biopsy was performed to evaluate a possible tuberculosis involvement in the liver. The diagnosis of metastatic breast carcinoma located in the sinusoidal area and cholestatic liver with extramedullary hematopoiesis foci was given using the histomorphological, immunohistochemical and histochemical findings. Radiological evaluation has an important role in staging of malignancies. However, it should be kept in mind that hepatic metastases may present without formation of a mass lesion, and unexpected laboratory results of cases without abnormal radiological features should raise the suspicion of a metastasis. Such materials should be evaluated in detail by making multiple serial sections in the pathology laboratory. Rare metastatic tumor growth patterns not causing a mass lesion such as sinusoidal or portal pattern, should also be kept in mind.

Study of PD-L1 Expression with Association of Pathological Factors and Molecular Subtypes in Breast Carcinoma.

Background Programmed death ligand 1 (PD-L1), expressed on cancer cells, shows varied results in the prognosis of breast cancer. This study was conducted to study the expression of PD-L1 in breast carcinoma and to correlate it with pathological, molecular classification and prognostic factors. Materials and Methods PD-L1 expression was correlated with tumor size, histopathological grade, necrosis, lymphovascular, perineurial invasion, lymph node metastasis, molecular classification, and survival in breast carcinoma cases. Results Fifty cases were included which showed statistically significant difference of PD-L1 with mean age, tumor size, histopathological grade, lymphovascular emboli, and lymph node metastasis ( p < 0.05). Estrogen receptor was strongly positive in 46%, progesterone receptor in 42%, and PD-L1 in 6% of cases. No statistically significant difference between pathological tumor-node-metastasis (TNM) staging and PD-L1 expression ( p = 0.354) was observed. Receptor operating characteristic curve analysis showed that at the cutoff of PD-L1 greater than 120, specificity was 56.1%, sensitivity 66.7%, negative predictive value 88.5%, and positive predictive value 25% for predicting living status. Conclusion PD-L1 is associated with poor prognostic factors including tumor size, histopathological grade, lymphovascular emboli, and lymph node metastasis in breast carcinoma. However, no significant association was observed between PD-L1 and pathological TNM stage or molecular subtypes of breast carcinoma. It is suggested that immunohistochemical reporting of PD-L1 should be standardized so that it is reproducible and reliable for the evaluation of breast carcinoma. Further, larger studies with extended follow-ups are recommended so that the exact role of PD-L1 as a prognostic marker in breast carcinoma could be ascertained.

Orbital metastasis from breast carcinoma presenting as an osteoblastic lesion

A 66-year-old female presented with a swollen and itchy eyelid for 4 weeks. A computed tomography (CT) scan revealed a lesion epicentered in the greater wing of the sphenoid and anterior lateral and superior orbital walls, predominantly showing osteoblastic features. Magnetic resonance imaging (MRI) demonstrated further calvarial and pachymeningeal involvement. Biopsy of the lesion demonstrated a poorly differentiated carcinoma. A distant history of breast cancer (20 years) prompted specific immunochemistry that confirmed breast carcinoma metastases. Staging positron emission tomography-computed tomography (PET) revealed multisystem spread. This report highlights the fact that breast carcinoma metastasis may rarely present with a predominantly osteoblastic lesion in the orbit.

Exploring the Integrated Role of AKT2, CD44v6, And MT1-MMP as Predictors of Axillary Lymph Node Metastasis in Invasive Breast Carcinoma of No Special Type.

Invasive breast carcinoma of no special type (IBC-NST) is the most common type of breast cancer, which mainly causes axillary lymph-node metastasis (ALNM). Building on our previous research, we wanted to explore the optimal combination of AKT2, CD44v6, and MT1-MMP for the ALNM prediction. The presence or absence of ALNM was used to separate 46 paraffin blocks containing IBC-NST primary tumors into two groups. Age, tumor grade, tumor size, receptor status (ER, PR, HER2, Ki-67, TOP2A), and test biomarker expression were evaluated. Biomarker expressions were assessed by IHC staining and categorized according to their respective cut-offs from our previous study, while other data were collected from archives. Data was gathered and analyzed using univariate, multivariate, and AUROC models. The expression of CD44v6 (OR: 12.77, 95% CI: 2.18-87.12, P=0.005) was identified as the independent variable for ALNM. Meanwhile, AKT2 expression (OR: 3.22, 95% CI: 0.36-22.41, P=0.237) and MT1-MMP expression (OR: 5.35, 95% CI: 0.83-34.54, P=0.078) did not demonstrate a statistically significant independent association in respect to ALNM. Combining AKT2 and MT1-MMP on CD44v6 increased overall accuracy by 4% compared to CD44v6 alone (AUROC 0.89 vs. 0.85). The combined usage of AKT2, CD44v6, and MT1-MMP revealed no significant change compared to CD44v6 alone. Due to the cost and practicality, we propose using CD44v6 as a predictor biomarker of ALNM in IBC-NST.

Transtorasik Akciğer Biyopsisi: Tek Bir Merkezdeki İlk Deneyimlerin Retrospektif Değerlendirmesi

Background: To evaluate our first experience on computed tomography (CT)-guided transthoracic lung biopsy and compare our results including complication rates, etc. with the literature. Materials and Methods: Thirty-four CT-guided transthoracic biopsies in 33 consecutive patients with lung lesions using a 15 cm long 16 gauge semi-automatic (coaxial) biopsy needle were retrospectively evaluated. Age, gender, size of the lesion, location, distance to pleura, needle insertion angle, patient position, presence of emphysema and/or complications (pneumothorax and pulmonary hemorrhage), radiological findings before, during and after the biopsy,and pathological diagnosis were retrieved from patient files. The diagnostic success and failure of the method, and complication rates were noted. Results: Pneumothorax and pulmonary hemorrhage were observed in 9 and 7 patients, respectively, and 4 patients had both. Application of a chest tube was necessary in only 4 patients (4 of 9 patients wirth pneumothorax). None of the patients with pulmonary hemorrhage required additional procedures. The biopsy sample was adequate for histopathologic evaluation in 32 patients with a diagnostic accuracy rate of 96.6%. The most frequent diagnosis was squamous cell carcinoma (11/33), followed by other types of primary lung tumors in 14, breast carcinoma metastasis in 2, and B-cell lymphoma in 1 patient. Conclusions: Our rate of complication due to CT-guided transthoracic lung biopsy seems to be comparable with the literature. Pneumothorax and pulmonary hemorrhage may occur in up to one fifth/fourth but the management of these complications does not require additional procedures in the majority of patients, and the diagnostic accuracy rate is high.

Acute appendicitis secondary to metastatic breast cancer. 12Years after first primary tumor diagnosis. A case report.

IntroductionMetastatic adenocarcinoma to the appendix is an uncommon finding, there are few published cases in the literature of appendicitis from metastatic breast carcinoma.Presentation of caseA 51-year-old female was admitted to the emergency department with a presumptive diagnosis of acute appendicitis with a past medical history of stage IV Breast Cancer 12 years ago. Appendectomy was performed, finding a perforated appendix. Anatomo-pathology examination revealed a semi-differentiated carcinoma involving the tip of the appendix.DiscussionGastrointestinal tract (GIT) metastases of breast carcinoma are an uncommon finding. Appendiceal metastases are a very uncommon finding, and the interval between diagnosis of the primary carcinoma and the metastases can be many years. There are no reports about whether right hemicolectomy provides better oncological outcomes than an appendectomy in stage IV BC.ConclusionThere are no guidelines for the management of this disease but unquestionably, multidisciplinary management leads to better outcomes.

Colonic metastasis of invasive lobular breast carcinoma 14 years after the initial diagnosis

A 57-year-old woman with a history of lobular carcinoma of the left breast (stage I, T1b-N0-M0, HER2/neu-negative; estrogen and progesterone receptor-positive) diagnosed 14 years ago, treated with modified radical mastectomy and tamoxifen, followed by surveillance for 5 years. She recently returned due to dysphagia, chest pain, hyporexia, nausea, vomiting, unintentional weight loss, and at 3 months later changes in bowel habits increased frequency and decreased consistency (Bristol-6), alternating with constipation (Bristol-1) ascites and pleural effusion.

Role of germline variants in the metastasis of breast carcinomas.

Most cancer-related deaths in breast cancer patients are associated with metastasis, a multistep, intricate process that requires the cooperation of tumour cells, tumour microenvironment and metastasis target tissues. It is accepted that metastasis does not depend on the tumour characteristics but the host’s genetic makeup. However, there has been limited success in determining the germline genetic variants that influence metastasis development, mainly because of the limitations of traditional genome-wide association studies to detect the relevant genetic polymorphisms underlying complex phenotypes. In this work, we leveraged the extreme discordant phenotypes approach and the epistasis networks to analyse the genotypes of 97 breast cancer patients. We found that the host’s genetic makeup facilitates metastases by the dysregulation of gene expression that can promote the dispersion of metastatic seeds and help establish the metastatic niche—providing a congenial soil for the metastatic seeds.