Metastatic lobular carcinoma of the breast masquerading as a primary rectal cancer

Abstract

BackgroundColorectal metastasis of lobular carcinoma of the breast is a diagnostic challenge. It may macroscopically simulate primary colon cancer or inflammatory bowel disease. In some cases, the interval between the primary breast cancer and metastatic colorectal lesions is so long that the critical records for diagnosis including history might be lost or missed.Case presentationReported herein is a case of metastatic lobular carcinoma of the breast masquerading as a primary rectal cancer developed in a 62-year-old Japanese woman. The case initially presented as a circumferential rectal lesion, and information on the patient’s history of breast cancer was not noted. As the result of endoscopic biopsy, diagnosis of poorly differentiated rectal adenocarcinoma was made. The lesion was surgically resected after chemo-radiotherapy. Histopathological examination of the resected specimen with hematoxylin and eosin (HE) stain revealed a single-file arrangement of the tumor cells, reminiscent of lobular carcinoma of the breast. Immunohistochemical analysis revealed an immunophenotype consistent with lobular carcinoma of the breast. Because further review of the patient’s history revealed an occurrence of ‘poorly differentiated adenocarcinoma of the breast’, which she had experienced 24 years earlier, the final diagnosis of the lesion was made as rectal metastasis from lobular breast carcinoma.ConclusionsPoorly differentiated adenocarcinoma of the colorectum is rarer than that of the stomach. Linitis plastica-type cancer of the colorectum is also rarer than that of the stomach. A lesson from the present case is that before we conclude a linitis plastica-type cancer of poorly differentiated type as a primary colorectal cancer, it is critical to exclude a possibility of metastatic colorectal cancer.

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

“…The invasive lobular cancer that represents 5%-10% of primary breast cancers, frequently involves unusual metastatic sites such as the gastrointestinal tract, the gynaecological organs, the peritoneum and meninges (10)(11)(12)(13)(14) in contrast to the invasive ductal cancer that follows the more conventional metastatic pattern of breast cancers and metastasizes in liver, lungs and brain (15,16).…”

Keep scalpel sheathed: A metastatic invasive ductal carcinoma mimics primary linitis plastica

“…One French retrospective cohort showed the median time interval from diagnosis to gastric metastases was 57 months . In two Japanese retrospective cohorts, the median time interval was beyond 3 years and 6 years. In one Japanese case report, the time interval was up to 11 years…”

Can Metastatic Breast Cancer Spread to the Colon?

“…First, almost all the metastatic colonic lesions present like primary GI tumors on radiography and endoscopy. They can present as poorly differentiated, lintis plastica type GI lesion and can be misdiagnosed as primary GI carcinoma [8]. Calafat et al and Easter et al reported metastasis of lobular breast carcinoma that presented as Crohn's disease [7,9].…”

“…The median interval between breast cancer and GI metastases is 6 or 7 years [8]. In many patients the history of primary breast cancer is known but Harsløf et al reported a case of colon metastasis compatible with lobular carcinoma of the breast although the primary breast cancer was never identified [13].…”