Synchronous Colonic Adenocarcinoma and Metastatic Lobular Carcinoma in a Colectomy Specimen: A Rare Finding

Abstract

Invasive lobular carcinoma is the second-most-common subtype of invasive breast carcinoma. Its metastatic pattern is different compared to invasive carcinoma—no special type. It metastasizes more often to the gastrointestinal tract, peritoneum, pleura, and ovaries. The extrahepatic gastrointestinal tract metastases occur mostly in the stomach and small intestine and less often in the colon and rectum.We present a case description of an 87-year-old woman admitted to our hospital with hematochezia, abdominal discomfort, fatigue, and weight loss. A colonoscopy revealed an exophytic tumor of the sigmoid colon. Metastatic disease was not found in imaging studies. A low anterior resection was performed. The pathologic examination revealed a collision tumor consisting of a poorly differentiated adenocarcinoma of the colon and metastatic lobular carcinoma. The diagnosis was challenging due to the lack of a previous history. Also, the diffuse architectural pattern and signet ring cells found may be in primary signet ring carcinoma of the colon as well as in carcinomas from other anatomical sites. Immunohistochemistry was helpful in making the diagnosis. A review of the literature revealed that this is the fourth case of metastatic breast carcinoma coexisting with colonic adenocarcinoma.

The Rare Diagnosis of Synchronous Breast and Colonic Cancers: A Case Report and Review of Literature

“…Up to 35% of patients with colorectal cancer have a family history of the disease, suggesting a hereditary predisposition, while only 10% of breast cancer are familial in nature [3]. Different malignancies have been diagnosed in coexistence with breast cancer, such as lymphoma, renal, prostate, esophagus, urinary bladder, uterus, thyroid, colon, melanoma, lung, gastrointestinal stromal tumor (GIST), rhabdomyosarcoma, and ovarian carcinoma [2,[4][5][6][7].…”

“…The occurrence of breast cancer bi-laterality is encountered more with the invasive lobular carcinoma phenotype, however, there are controversies also about the origin of synchronous cancer (independent primary or metastatic focus) [ 8 ]. Colorectal cancer appears with synchronous different primary cancers such as small intestine, ovary, uterus, cervix, mammary gland, kidney, bladder, nasopharynx, lung, stomach, ureter, prostate, oesophagus, thyroid gland, and liver [ 6 , 9 ]. In the inherited cancer disorder, Li-Fraumeni syndrome, which is related to TP53 genetic mutation, patients may encounter early-onset core malignancy as brain tumors, breast cancer, sarcomas, adrenocortical tumors, and leukemia.…”

Lobular Mammary Carcinoma Presenting as an Obstructing Rectal Mass

“…Histopathological diagnosis can be challenging in the absence of the diagnosis of primary breast cancer as it was in our case. In addition, the “signet-ring” morphology of lobular carcinoma may mimic other primary tumors, i.e., gastric carcinoma [ 13 ] and primary signet ring cell carcinoma with tubular adenoma of the rectum [ 14 ], and even rarer conditions such as synchronous primary colonic adenocarcinoma and metastatic lobular carcinoma as described in a case report [ 15 ] making the diagnosis more difficult.…”

Invasive Lobular Carcinoma with Extracellular Mucin Production: Description of a Case and Review of the Literature

“…Invasive lobular carcinoma (ILC) of the breast is the second most common variant of breast carcinoma. It accounts for 5-15% of invasive mammary carcinomas [1]. It usually affects older patients.…”

“…It is more often bilateral and multifocal or multicentric compared to invasive carcinoma of no special type. Also, the metastatic pattern of ILC is different, showing a tendency to metastasize to the gastrointestinal tract, meninges, bone and the female genital tract [1].…”