Rectal Carcinoma Metastatic to the Male Breast after 7 Years: Case Report

Wang, Ting; Lv, Yonggang; Qu, Yan; Yuan, Shi-Fang; Ling, Rui; Chen, Jianghao; Lin, Chen; Yi, Jun

doi:10.1159/000332225

Cited by 10 publications

(4 citation statements)

References 20 publications

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“…Compared to the liver or lung metastases, rectal cancer breast metastasis (RCBM), let alone vulvar metastasis, is rather uncommon in existing literature (17)(18)(19). Except 2 male patients, RCBM mainly involved the female in previous reports (20,21). The rareness of this entity might be ascribed to its hormone status and the relatively poor blood supply of a large amount of fibrous tissue, especially in Eastern female (22,23).…”

Section: Discussionmentioning

confidence: 95%

Case Report: Systemic treatment for breast and vulvar metastases from resected rectal signet ring cell carcinoma

Han

Yang

et al. 2023

Front. Oncol.

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BackgroundBreast and vulvar metastases from rectal signet ring cell carcinoma (SRCC) represent a rare and obscure clinical entity associated with poor survival. Managing patients with metastatic rectal SRCC is extremely challenging due to the absence of high-quality evidence.Case presentationA 26-year-old woman presented with progressively worsening anal pain, constipation, and hematochezia for approximately two years. Following the diagnosis of locally advanced rectal cancer (cT3N0-1M0), she received neoadjuvant chemotherapy with modified FOLFOX6 regimen and underwent laparoscopic abdominoperineal resection. Metastases to the breast and vulva developed during postoperative chemotherapy. Genetic testing revealed RAS/BRAF wild-type and microsatellite instability (MSI)-low status. Though sequential administration of irinotecan plus tegafur and tegafur plus raltitrexed-based chemotherapy in combination with bevacizumab, the disease progressed rapidly. Sadly, the patient passed away 15 months after initial diagnosis due to rapidly progressive disease.ConclusionRectal SRCC is associated with younger on-set, aggressive behaviors, and worse survival outcomes. Due to poor cohesiveness, SRCC tends to develop metastases. A patient’s medical history and immunohistochemical staining (such as CK20, CK7, and CDX-2) can aid in identifying the tumor origin of breast and vulvar metastases. Mutations and signaling pathways predominant in the tumorigenesis of SRCC remains unveiled. There is poor effect of conventional chemotherapies, targeted and immunotherapies for colorectal adenocarcinoma on SRCC, so novel therapies are needed to treat this patient population.

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Section: Discussionmentioning

confidence: 95%

Case Report: Systemic treatment for breast and vulvar metastases from resected rectal signet ring cell carcinoma

Han

Yang

et al. 2023

Front. Oncol.

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“…Skin changes such as redness and swelling may also be present, but these can also be seen in advanced breast cancer. Diagnosis based on clinical manifestations alone is difficult ( 7 – 9 ). Unfortunately, patients with breast metastases from rectal cancer do not show any specific imaging characteristics, and previous literature reports have shown that a significant number of patients are misdiagnosed with primary breast cancer or benign breast diseases based on imaging alone ( 10 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

Breast mass as the first sign of metastasis from rectal carcinoma: a case report and review of the literature

et al. 2023

Front. Oncol.

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We present a case report of a 41-year-old woman who developed a left breast mass 18 months after undergoing Dixon rectal cancer surgery. The purpose of this case report is to highlight the possibility of breast metastases in patients with colorectal cancer and emphasize the importance of careful evaluation and follow-up as well as timely and accurate diagnosis and management of the metastatic disease. During the physical examination in 2021, we noted that the lower border of the mass was 9 cm from the anal verge and that it occupied approximately one-third of the intestinal lumen. A pathological biopsy revealed the mass in the patient’s intestinal lumen was a rectal adenocarcinoma. The patient underwent Dixon surgery for rectal cancer and received subsequent chemotherapy. The patient had no prior history of breast-related medical conditions or a family history of breast cancer. During the current physical examination, we discovered multiple lymphadenopathies in the patient’s left neck, bilateral axillae, and left inguinal region, but none elsewhere. We observed a large erythema of about 15x10 cm on the patient’s left breast, with scattered hard nodes of varying sizes. Palpation of the area beyond the upper left breast revealed a mass measuring 3x3 cm. We conducted further examinations of the patient, which revealed the breast mass and lymphadenopathy on imaging. However, we did not find any other imaging that had significant diagnostic value. Based on the patient’s conventional pathology and immunohistochemical findings, combined with the patient’s past medical history, we strongly suspected that the patient’s breast mass was of rectal origin. This was confirmed by the abdominal CT performed afterward. The patient was treated with a chemotherapy regimen consisting of irinotecan 260 mg, fluorouracil 2.25 g, and cetuximab 700 mg IV drip, which resulted in a favorable clinical response. This case illustrates that colorectal cancer can metastasize to unusual sites and underscores the importance of thorough evaluation and follow-up, particularly when symptoms are atypical. It also highlights the importance of timely and accurate diagnosis and management of metastatic disease to improve the patient’s prognosis.

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“…The response to this regimen was poor, so the NAC was changed to vinorelbine. Following the last round of vinorelbine, modified radical mastectomy and dermoplasty were performed ( 12 ). Gur et al presented a similar case.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is speculated that this may be the route for breast metastasis. Further studies might shed more light on this unorthodox hypothesis (3,4,(11)(12)(13)(14)(15)(16)(17) (Table 3).…”

Section: The Routes Of Breast Metastases Secondary To Rectal Cancermentioning

confidence: 99%

Rare case of a male breast tumour secondary to poorly differentiated rectal adenocarcinoma

Xia¹,

Zhao²,

Jiang³

et al. 2020

Transl Cancer Res TCR

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Rectal cancer metastasis to the breast is rare. A case history is presented of a 57-year-old man with breast metastases from rectal carcinoma. However, this patient did not have metastasis in common metastatic sites, such as the liver, lung, and other organs. The patient had undergone chemotherapy for advanced rectal carcinoma 6 months earlier and presented with a mammary mass. An ultrasound-directed core needle biopsy of the breast mass was performed. Cytology indicated an adenocarcinoma with poor to moderate differentiation in the breast mass Immunohistochemistry (IHC) showed cytokeratin (CK) expression with a pattern that is characteristic of colorectal tumours: CK7(−), CK20(+), CDX2(−), Villin(+) TOPOII(−), and a Ki-67 index of 30%. The 3 main breast tumour markers were negative. Based on these histopathological and immunohistochemical findings, the patient was diagnosed with breast metastases from rectal carcinoma. Distant metastasis should be taken into account when a patient has a medical history of rectal adenocarcinoma, even when a rare metastasis site is involved. We should be vigilant when patients have some features that are favorable for metastasis. Histopathological characteristics and immunohistochemical tests are helpful for diagnosis. Regardless of surgical treatment after neoadjuvant chemotherapy, standard chemotherapy regimens for intestinal tumors, and EGFR molecular-targeted drugs, there is no obvious effect and the prognosis is poor. The treatment method needs further study.

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Rectal Carcinoma Metastatic to the Male Breast after 7 Years: Case Report

Cited by 10 publications

References 20 publications

Case Report: Systemic treatment for breast and vulvar metastases from resected rectal signet ring cell carcinoma

Case Report: Systemic treatment for breast and vulvar metastases from resected rectal signet ring cell carcinoma

Breast mass as the first sign of metastasis from rectal carcinoma: a case report and review of the literature

Rare case of a male breast tumour secondary to poorly differentiated rectal adenocarcinoma

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