Gastric metastasis and peritoneal carcinosis revealing primary breast cancer: an unusual presentation

Abstract

Breast cancer is the most frequent cancer among women. Gastrointestinal tract metastases are uncommon and might be misidentified as primary carcinoma.

A noteworthy case-study involved 53-year-old-woman complaining from epigastric pain, ascites and overall health decline. Initial investigations were inconclusive, prompting laparoscopic peritoneal biopsies which revealed independent cell proliferation. Subsequently, a second look upper digestive endoscopy showed multiple gastric ulcerations suggestive of gastric carcinoma. Histologic examination confirmed independent cell proliferation with estrogen receptors expression, a characteristic feature of breast carcinoma. Further investigations led to bilateral invasive lobular breast carcinoma diagnosis. Epirubicin cycophosphamide was prescribed after progression under letrozole ribocilib therapy.

This case aims to raise awareness among clinicians about the importance of ruling out breast cancer in patients with peritoneal carcinosis and paying attention to digestive symptoms in breast cancer patients with careful gastric endoscopic examination to avoid misdiagnosis.

Executive summary

• Gastrointestinal metastases and peritoneal carcinosis represents rare metastatic sites of breast cancer with unfavorable prognosis.

• Invasive lobular carcinoma is the most frequent histologic type involved in gastrointestinal metastases.

• Digestive clinical symptoms are not specific and indicates upper-digestive endoscopy with careful gastric mucosa examination and biopsies to avoid misdiagnosis.

• Independent cells proliferation with linear cords distribution within the gastric mucosa should evoke the diagnosis of gastric metastasis of lobular carcinoma.

• Immunohistochemistry is mandatory to distinguish between gastric metastasis of breast carcinoma and primitive gastric carcinoma. Typical profile of gastric metastasis is ER positive, PR positive, CK7 negative and CK20 negative.

Keywords: :

• breast cancer
• GI tract
• lobular breast carcinoma
• metastases
• peritoneal carcinosis

Author contributions

S Ayadi: conception and first revision, S Monastiri: data collection and literature review, M Hammami: writing the first draft of the paper, I Samaali and M Kammoun: literature review, Y Zaimi: second revision, A Blel and R Aloui: figure preparation, AB Safta: supervising and critical review, L Mouelhi: supervising and critical review.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.