Breast Metastatic Localization of Signet-Ring Cell Gastric Carcinoma

Abstract

Metastatic tumors in the breast are quite rare and constitute 0,5 to 6% of all breast malignancies. They often occur in a polymetastatic context. Gastrointestinal lesions rarely metastasize to the breast. The first case of a metastasis deposit to the breast and ovary from gastric signet-ring cell carcinoma was reported in the literature in 1999. Since this report, only 5 cases have been reported. We present a case report of a 37-year-old woman who complained of a lump in the left breast. Two months earlier, the woman underwent a subtotal gastrectomy and a total hysterectomy with double anexectomy, which histologically was diagnosed of gastric signet-ring carcinoma, disseminated with Krukenberg's tumor. In those days, the patient was following a chemotherapy treatment. A core needle biopsy of the lesion in left breast revealed cells with signet-ring features, with probably gastric origin.

Breast metastasis of gastric signet-ring cell carcinoma

“…They tend to have the same size as they are palpated (Boutis et al, 2006). Microcalcifications and the occurrence of multiple tumor nodules are rare (Parrell Soler et al, 2011). On sonography, the focal lesions are almost the same as the presentation of the mammography.…”

“…The commonest cause is contralateral breast carcinoma. The most common solid tumors metastasizing to the breast from other sites are malignant melanoma, lymphoma, rhabdomyosarcoma, lung tumors, ovarian tumors, renal cell carcinoma, leukemia, thyroid carcinoma, cervical carcinoma, gastrointestinal carcinoma, genitourinary tumors, and soft tissue sarcoma (Parrell Soler et al, 2011). Therefore, the prognosis of metastases of the breast is important.…”

“…The average age of the patients is 47 years and premenopausal women are more commonly affected (Parrell Soler et al, 2011).…”

“…The immunoprofile of breast metastases from stomach adenocarcinomas is positive for adenocarcinoma markers such as CK7, CK20, and carcinoembryonic antigen (CEA) while negative for ER, PR, GCDFP-15, as well as for C-erB-2 (in up to 20% it can be positive) (Boutis et al, 2006;Parrell Soler et al, 2011). It has been demonstrated that immunohistochemical staining for CK alone cannot distinguish primary breast cancer and metastatic breast carcinoma from gastric cancer (Sato et al, 2008).…”

“…Staining for ER, PR, and GCDFP-15 is specific for metastatic breast carcinomas while CK20 is highly specific for primary gastric carcinomas (O'Connell et al, 2005). Therefore, biopsy of the breast lesions and histopathologic examination should be performed to distinguish a primary breast cancer from a metastatic tumor (Parrell Soler et al, 2011).…”