Gastric signet-ring adenocarcinoma presenting with breast metastasis

Abstract

Breast metastases from gastric cancer are extremely rare. A case report of a 37-year-old female with breast inflammatory invasion and ascites is described. Breast biopsy revealed carcinomatous invasion of the lymphatics from adenocarcinoma cells with signet-ring features. Estrogen (ER) and progesterone receptors (PR) and c-erb-B2 were negative. Upper gastrointestinal endoscopy revealed a prepyloric ulcerative mass. Histopathologic examination of the lesion showed infiltration from a high-grade adenocarcinoma, identical with that of the breast. Immunostaining was positive for cytokeratins CK-7 and CK-20 and CEA and negative for ER and PR. Ascitic fluid cytology was positive for adenocarcinoma cells. Mammography was not diagnostic. Abdominal CT scanning revealed large ovarian masses suggestive of metastases (Krukenberg's tumor). A cisplatin-based regimen was given but no objective response was observed. The patient died six months after initial diagnosis. A review of the literature is performed.

Breast metastasis of gastric signet-ring cell carcinoma

“…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).…”

“…The presence of a heterogeneous echoic mass in the left adnexal area may suggest metastatic ovarian involvement while more persuasive proof was lacking. Although the metastatic involvements of breast and ovary are extremely rare and there are only five cases that have been reported, the selective invasion of hormone-dependent organs may explain why breast and ovary are involved (Boutis et al, 2006).…”

“…The masses are generally round with fairly well-defined margins appearing as benign lesions and are superficially located in the upper outer quadrant. 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).…”

“…The most common lymphatic source of breast metastasis is contralateral primary breast cancer. Boutis et al (2006) thought that increased blood supply of the breast was proposed as the mechanism for breast metastasis in premenopausal women. Premenopausal women are more commonly affected.…”

“…They are more likely to be encapsulated within the subcutaneous tissue adjacent to the mammary stroma so can be palpated (Akçay, 2002). The breast invasion is the initial manifestation of metastatic disease in 25%-40% of cases (Boutis et al, 2006). Approximately two-thirds of the invasions present in the upper outer quadrant of the breast (Tian et al, 2016).…”