Breast Cancer Metastasis in the Stomach: When the Gastrectomy Is Indicated ?

Abstract

Background:Breast cancer is the most common malignant neoplasm in the female population. However, stomach is a rare site for metastasis, and can show up many years after initial diagnosis and treatment of the primary tumor. Aim:Analyze a case series of this tumor and propose measures that can diagnose it with more precocity. Methods:Were analyzed 12 patients with secondary gastric tumors. Immunohistochemistry has demonstrated that primary tumor was breast cancer. We retrieved information of age, histological type, interval between diagnosis of the primary breast cancer and its metastases, immunohistochemistry results, treatment and survival. Results:The mean age was 71.3 years (ranging 40-86). Ten cases had already been underwent mastectomy in the moment of the diagnosis of gastric metastasis. Two patients had diagnosis of both primary and secondary tumors concomitantly. At average, diagnosis of gastric metastasis was seven years after diagnosis of primary breast cancer (ranging 0-13). Besides, nine cases had also metastases in other organs, being bones the most affected ones. Immunohistochemistry of the metastases has shown positivity for CK7 antibody in 83.34%, estrogen receptor in 91.67%, progesterone receptor in 66.67% and AE1AE3 antibody in 75%, considering all 12 cases. Moreover, CK20 was absent significantly (66.67%). The positivity of BRST2 marker did not present statistical significance (41.67%). Eight cases were treated with chemotherapy associated or not with hormonal blockade. Surgical treatment of gastric metastasis was performed in four cases: three of them with total gastrectomy and one with distal gastrectomy. Follow-up has shown a mean survival of 14.58 months after diagnosis of metastasis, with only two patients still alive. Conclusion:Patients with a history of breast cancer presenting endoscopic diagnosis of gastric cancer it is necessary to consider the possibility of gastric metastasis of breast cancer. The confirmation is by immunohistochemistry and gastrectomy should be oriented in the absence of other secondary involvement and control of the primary lesion.

Pyloric Metastases from Primary Breast Cancer- A Case Report and Literature Review

“…A localized pattern usually causes a segmental thickening of the lumen, whilst circumferential infiltration causes lumen narrowing and presents as obstruction. The most commonvariant of stomach involvement is a "linitisplastica" appearance, affecting muscle layer and submucosae; this is foundin 73% of cases [13] . There is diffuse intramural infiltration of the gastric wall by the tumor; this results in narrowing of the stomach lumen, rigidity, and diminished peristalsis [14] .…”

“…If the interval between the primary breast cancer and occurrence of gastrointestinal lesions is lengthy, essential elements of the history may be missed. Complete immunohistochemistry analysis is essential at the time of diagnosis, to distinguish between primary and metastatic disease.The immunohistochemistry panel included markers that have traditionally been detected in breast carcinomas: oestrogen receptor protein (ER), progesterone receptor protein (PR), GCDFP-15, and CAM 5.2 [13] .…”

Gastric Metastasis of Breast Cancer after 20 Years

“…Palavras Chave Carcinoma da mama · Metástases · Estômago · Cancro · Endoscopia Breast cancer metastases in the gastrointestinal tract are rare (0.6%) [1], and when they occur, they are more frequent in the first years after breast cancer diagnosis [2]. We describe a rare case of breast cancer metastasis in the stomach presenting 23 years after breast cancer diagnosis and treatment.…”

Breast cancer metastasis to the stomach

“…In 45 cases immunohystological study of the biopsies from gastric lesions or gastric wall were taken before starting any treatment; considering patients who underwent gastrectomy, nine [23,26,27,28,35,42,43,45] were taken after surgical treatment whereas three [23,28,43] were done before, but authors decided to perform surgery because they suspected primary gastric cancer or they couldn't exclude it.…”