Clinical features and prognosis of breast cancer with gastric metastasis

Abstract

Breast cancer rarely metastasizes to the gastrointestinal tract, including the stomach. Due to the rarity of this metastasis, it is occasionally confused with a primary stomach malignancy. However, discriminating characteristic features with clinical implications may exist. The aim of the current study was to analyze the clinical features and prognosis of breast cancer with gastric metastasis. Between January 1994 and October 2016, 13 patients at Samsung Medical Center (Seoul, Korea) were clinically or pathologically determined to have breast cancer with gastric metastasis. The present study retrospectively collected clinicopathological data from the electronic medical records of these 13 female patients. At breast cancer diagnosis, the median patient age was 45 years. A total of 7 patients (53.8%) presented with invasive lobular carcinoma (ILC) and 6 (46.2%) with invasive ductal carcinoma. Of the 13 patients, 11 were stage I-III at initial breast cancer diagnosis and underwent surgery. Positivity of breast cancer tissue samples for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) was 92.3, 76.9 and 0%, respectively. Positivity of gastric metastasis lesions, based on immunohistochemistry results, was 81.8, 50 and 0% for ER, PR and HER2, respectively. The stomach was the location of the first metastatic lesion in 6 out of the 11 patients (54.5%) with de novo stage I-III cancer. The median time interval from initial breast cancer diagnosis to stomach metastasis was 77.5 months. The 3-year survival rate was 79.1%, and the estimated mean survival time was 35.1 months. Breast cancer with gastric metastasis is rare, and due to this fact, a thorough pathological review and greater clinical suspicion are required in these cases.

Gastric Metastasis of Invasive Lobular Breast Carcinoma, a Current Diagnostic and Treatment Challenge - A Review

“…Breast cancer pathologic subtypes which had metastasis of gastrointestinal tract are often invasive lobular more than invasive ductal carcinomas (17). Invasive lobular carcinoma or luminal-type breast cancer (ER positive) tends to metastasize to the stomach at a higher frequency compared with other types of breast cancer (18,19,20).…”

Gastric metastases from invasive lobular carcinoma of the breast: Case report

“…Tumor cells with these features are characteristic of a subtype of primary gastric malignancy: Signet ring cell type gastric carcinoma [5] . However, tumor cells of ILC also have this morphology, making diagnosis a difficult task [1 , 2 , 6] . Therefore, the only way to reach the diagnosis is through immunohistochemical study.…”

“…Other markers have emerged to distinguish between gastric metastases from breast cancer and primary gastric malignancy. While metastatic breast carcinoma is usually positive for cytokeratin 7 (CK7, 90%), gross cystic disease fluid protein 15 (GCDFP-15), and negative for cytokeratin 20 (CK20) [ [1] , [2] , [3] , 6 , 9] , primary gastric carcinoma is negative for CK7 and GCDFP‐15 and positive for CK20 [6] , [7] , [8] . Recently, GATA-3 has emerged as a marker of urothelial and breast carcinoma.…”

“…IDC usually metastasize to local and distant lymph nodes, liver, lungs, brain, and bone [3 , 4] . In contrast, ILC shows a distinct systemic metastatic pattern and has a higher incidence of metastases to the gastrointestinal tract, gynecological organs, meninges, pleura, peritoneum, and skin [1] , [2] , [3] , [4] , [5] , [6] .…”

A Misdiagnosis of a Breast Tumor: Histology Solves It

“…Breast metastases from gastric carcinomas are associated with a poor prognosis, and the majority of patients die within 1 year. 3,4 Patients who develop brain metastases tend to have even poor prognosis, with shorter overall survival. Besides BRCA mutations, several other mutations have been linked to this clinical picture, namely CDH-1.…”