Gastrointestinal tract metastasis presenting as intussusception in invasive lobular carcinoma of the breast: A case report. (2019)

• Record Type: Journal Article
• Authors: Mosiun, Joanne Aisha; Idris, Muhammad Syafiq bin; Teoh, Li Ying; Teh, Mei Sze; Chandran, Patricia Ann; See, Mee Hoong
• Is Part Of: International journal of surgery case reports. Volume 64(2019)
• Page Start: 109
• Page End: 112
• Publication Date: 2019
• Subjects: Breast cancer -- Invasive lobular carcinoma -- Gastrointestinal metastasis -- Intussusception -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.10.003
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Gastrointestinal (GI) tract metastasis in breast cancer is rare and occurs more commonly in invasive lobular carcinoma. The interval between the index breast cancer and GI tract spread may be as long as 30 years. 20% of patients with GI tract metastasis are asymptomatic, and detection may rely on physical examination and imaging. Management follows the principles of treatment in systemic disease in breast cancer, with consideration for surgery in obstruction, perforation or bleeding. Abstract: Introduction: Breast cancer metastasis to the gastrointestinal (GI) tract is rare and occurs more frequently in invasive lobular carcinoma. Patients may be asymptomatic or present with variable vague symptoms that may be mistakenly attributed to side effects of chemotherapy or other benign GI diseases. Treatment follows the principles of systemic disease and includes hormonal therapy, chemotherapy and signal transduction inhibitors, with surgical intervention indicated for complications such as obstruction, perforation and hemorrhage. Presentation of case: We present the case of a female patient with a history of invasive lobular breast carcinoma who had undergone mastectomy and axillary dissection, followed by chemoradiotherapy. Over the next nine years, she developed ovarian and bone metastases for which appropriate treatment was provided. A right iliac fossa mass was discovered during routine clinic review, though she remained asymptomatic. Computed tomography scan showed ileocecal intussusception. Histopathological examination of the right hemicolectomy specimen following emergency surgery confirmed metastatic invasive lobular carcinoma to the GI tract. Discussion: GI tract metastasis may present 30 years after the primary breast cancer. Up to 20% of patients may be asymptomatic as shown by Montagna et al. When present, symptoms are commonly non-specific and vague. Histological diagnosis is challenging. GI metastasis typically appears as intramural infiltration of the bowel wall by small cells arranged in cords. Conclusion: It is important to maintain a suspicion for GI tract metastasis in breast cancer patients who present with abdominal mass or GI symptoms, as this aids in prompt institution of accurate and appropriate management.