Metastasis to the stomach is very rare in the case of breast cancer (BC). The incidence rate of gastric metastasis (GM) is estimated to be about 0.3%. In general, the most common areas of BC metastasis are bone, liver, and lung. Retrospective studies have found that the majority of GM is derived from lobular breast cancer compared with other breast cancer subtypes and higher percentages are hormone positive. Previous studies suggest varying intervals between diagnosis of primary breast cancer and the detection of GM anywhere from 5 to 20 years. Unfortunately, published data is limited to single case reports or small series. Case Description/Methods: Patient is a 73 year old female past medical history of breast cancer initially diagnosed 13 years prior with stage IIB invasive right breast lobular carcinoma ER/PR positive, HER2 negative. Patient received right mastectomy and completed chemotherapy and radiation without evidence of metastasis. Subsequent imaging including PET scans revealed no evidence of disease. 10 years later biopsy of left breast showed moderately differentiated invasive carcinoma ER/PR positive, HER2 negative. Patient underwent mastectomy with node sampling that was negative for involvement. Patient was continued on chemotherapy. PET scan and brain MRI done 3 months prior to EGD showed no evidence of disease. Patient presented to our outpatient GI clinic with complaints of dysphagia. She had an episode of suspected food impaction relieved by vomiting. Patient was experiencing epigastric discomfort including occasional globus sensation for several months prior to the incident. EGD showed erythematous gastric mucosa with nodularity no obvious mass was found. Biopsies revealed ER/PR positive, HER2 negative, metastatic adenocarcinoma in gastric body and antrum. Patient decided not to pursue aggressive measures in regards to metastasis. She was started on PPI twice daily which helped alleviate epigastric symptoms. Repeat EGD showed improvement of gastritis (Figure 1). Discussion: Reports on GM from breast cancer are limited do to the rarity. In reviewing previous studies there is a similar theme. GM presents without other signs of metastasis. Our patient had multiple negative scans falsely suggesting no metastasis. Although infrequent, physicians should still consider the possibility of GM in patients with breast cancer and non specific GERD symptoms. More so in patients with history of lobular carcinoma and hormone positive subtypes.[3699] Figure 1. Endoscopic imaging of gastric metastasis.
Introduction: Primary duodenal neuroendocrine carcinoma (NEC) is a rare and highly aggressive malignancy with very poor prognosis. There is no established treatment due to its rarity. Treatment regimens used for small cell lung cancer (SCLC) are used to treat neuroendocrine carcinoma, due to its clinical and histopathological similarities. Therapeutic strategies are poorly understood and not well defined. There is no standardization of therapy even for limited disease and usually multimodal treatment approach is used. Etoposide based treatment regimens have been used mostly in advanced stages. We herein report a case of an aggressive primary duodenal neuroendocrine tumor with excellent response to oxaliplatin-based chemotherapy regimen. Case Description/Methods: We describe a case of a 72-year-old caucasian male who presented to emergency room with abdominal bloating and constipation. He was found to have peritoneal carcinomatosis and marked hydronephrosis in computed tomography (CT) of the chest/abdomen/pelvis. He was further evaluated by urology, oncology, and gastroenterology team. He had paracentesis with removal of 4 L of ascitic fluid. He underwent esophagogastroduodenoscopy, endoscopic ultrasound, and a colonoscopy for further assessment. He was found to have a large mass in the duodenum which upon biopsy was consistent with grade 4 poorly differentiated neuroendocrine carcinoma. Positron emission tomography dotadate scan, peritoneal biopsy and peritoneal fluid cytology further confirmed metastatic neuroendocrine carcinoma. His tumor markers showed elevated Ca 19-9 and chromogranin levels at presentation. Due to his poor performance status and concerns for intolerability to etoposide, he was started on FOLFOX chemotherapy. He completed 12 cycles of chemotherapy with near complete resolution of his disease as evidence by his positron emission tomography dotadate scan and improvements in his tumor markers. Due to excellent response and disease remission, he is currently on xeloda with omission of oxaliplatin. Discussion: Primary duodenal neuroendocrine carcinoma is a relatively rare malignancy with reported incidence of 0.4-2% among all duodenal malignancies. The prognosis is dismal due to presentation as advanced stage at diagnosis. Oxaliplatin based regiments have been shown to have promising anti-tumor activity in gastrointestinal neuroendocrine cancers, however the available data in duodenal gastrointestinal neuroendocrine cancers are very limited.
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