From the Breast to the Bowel: An Unconventional Metastatic Presentation

Abstract

Breast cancer is the most common cancer in women. The common sites of metastasis include the lungs, liver, and, infrequently, the gastrointestinal (GI) tract. A 72-year-old Caucasian female presented to the hospital with nausea and vomiting, diarrhea, intermittent abdominal pain, and unintentional weight loss. She had had a past medical history of bilateral lobular breast carcinoma and severe iron-deficiency anemia treated with iron transfusions. On arrival, the examination was significant for hypotension and pallor. Laboratory investigations revealed abnormal liver enzymes and raised tumor markers Ca-125 and carcinoembryonic antigen. Imaging studies established a diagnosis of distal small bowel obstruction. The surgical intervention showed the presence of a small bowel tumor, the biopsy findings of which were consistent with metastatic breast cancer, with ER and PR positive but HER-2 negative. She was managed with a selective estrogen receptor degrader and CDK4/6 inhibitor and has been in remission since. Metastasis to the small bowel from the breast is a very rare occurrence. Clinicians should thus maintain a modest amount of suspicion when encountering an uncommon GI presentation of primary breast malignancy. We describe the case of metastatic breast cancer with an atypical GI presentation.

Rare Metastases in Colorectum of Infiltrating Ductal Breast Cancer: A Rare Case Report and Review

“…Breast cancer frequently metastasizes to the liver, lungs, brain, adrenals, and, very rarely, the bones, but metastases to the GI tract is quite atypical [8]. The reported rates of GI metastases from breast cancer were rather low as approximately 4-18% of metastatic breast cases; furthermore, rates of colonic metastases were extremely low as 3% [9][10][11][12][13].…”

“…Infiltrating ductal carcinomas is far less likely to metastasize to GI [18][19][20], which is as reported by us. And GI tract involvement occurs more often in the stomach and small bowel when compared to colon and rectum [8].…”

To Identify Small Bowel Metastasis From Lobular Breast Cancer on 18F-Fluoroestradiol PET/CT

“…Breast cancer frequently metastasizes to the liver, lungs, brain, and the bones. Occult metastases to the small bowels are very rare, and usually present as small bowel obstruction 5–9 . FES uptake has different biodistribution with the more common PET tracer FDG and is influenced by anatomic site 8,10 .…”