Biliary and pancreatic metastases of breast carcinoma: Is surgical palliation indicated?

Abstract

Obstructive jaundice developed in a patient concomitantly with the diagnosis of breast carcinoma. Abdominal exploration disclosed a metastatic tumor in the head of the pancreas, the distal bile duct, and the gallbladder. A cholecystectomy and choledochojejunostomy were performed and later, because of intestinal obstruction, the patient underwent gastrojejunostomy. Pathological examination demonstrated metastatic lobular carcinoma of breast with strongly positive staining for estradiol. Additional hormonal therapy has been given to the patient since the operation. The patient is alive 16 months after the diagnosis of her disease. This case suggests that a vigorous diagnostic approach should be adopted in every jaundiced patient with metastatic breast cancer in order to exclude causes of jaundice other than diffuse metastatic involvement of the liver. Patients with extrahepatic biliary metastasis should be treated by aggressive surgical treatment, combined with systemic therapy which can offer them significant palliation and better survival.

A Rare Cause of Distal Bile Duct Stenosis

“…In autopsy series of patients with breast cancer, metastatic spread to the pancreas can be detected in 11-17%, which is comparable to the frequency of metastases to the kidneys or the heart muscle and ranges far behind metastasis to lymph nodes, lung, or liver [12][13][14].…”

A Biliary Recurrence of a Breast Cancer: Case Report and Review of the Literature

“…Pappo et al [11] reported a case of an obstructive jaundice developed in a patient concomitantly with the diagnosis of breast carcinoma. After a vigorous surgical diagnostic approach, pathological examination demonstrated metastatic lobular carcinoma of breast in the head of the pancreas, the distal bile duct, and the gallbladder with strongly positive staining for estradiol.…”

Billiary obstruction in a metastatic tumor of the pancreas from breast cancer

“…[12] The most common mode of metastatic spread to pancreas is direct invasion from cancers of neighboring organs, followed by lymphatic and hemato-geneous dissemination as in renal-cell and lung-carcinoma. [34]…”

“…To the best of our knowledge, there have been only few cases of pancreatic-metastasis from carcinoma breast reported in the literature so far. [23456]…”

“…[123] Breast cancer accounts for 5–13% cases of all pancreatic-metastases. [34] The pancreatic-metastases does not manifest clinically, and hence most of the reported-cases are from incidentally-detected finding from autopsy-series. [25]…”