Jones Gregory E, Strauss Dirk C, Forshaw Matthew J, Deere Harriet, Mahedeva Ula, Mason Robert C
Department of General Surgery, Guy's and St Thomas' NHS Trust, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
World J Surg Oncol. 2007 Jul 9;5:75. doi: 10.1186/1477-7819-5-75.
The stomach is an infrequent site of breast cancer metastasis. It may prove very difficult to distinguish a breast cancer metastasis to the stomach from a primary gastric cancer on the basis of clinical, endoscopic, radiological and histopathological features. It is important to make this distinction as the basis of treatment for breast cancer metastasis to the stomach is usually with systemic therapies rather than surgery.
The first patient, a 51 year old woman, developed an apparently localised signet-ring gastric adenocarcinoma 3 years after treatment for lobular breast cancer with no clinical evidence of recurrence. Initial gastric biopsies were negative for both oestrogen and progesterone receptors. Histopathology after a D2 total gastrectomy was reported as T4 N3 Mx. Immunohistochemistry for Gross Cystic Disease Fluid Protein was positive, suggesting metastatic breast cancer. The second patient, a 61 year old woman, developed a proximal gastric signet-ring adenocarcinoma 14 years after initial treatment for breast cancer which had subsequently recurred with bony and pleural metastases. In this case, initial gastric biopsies were positive for both oestrogen and progesterone receptors; subsequent investigations revealed widespread metastases and surgery was avoided.
In patients with a history of breast cancer, a high index of suspicion for potential breast cancer metastasis to the stomach should be maintained when new gastrointestinal symptoms develop or an apparent primary gastric cancer is diagnosed. Complete histopathological and immunohistochemical analysis of the gastric biopsies and comparison with the original breast cancer pathology is important.
胃是乳腺癌转移较少见的部位。基于临床、内镜、放射学和组织病理学特征，很难将胃的乳腺癌转移灶与原发性胃癌区分开来。做出这种区分很重要，因为胃的乳腺癌转移灶的治疗通常采用全身治疗而非手术治疗。
首例患者为一名51岁女性，在接受小叶乳腺癌治疗3年后出现明显局限性印戒细胞胃腺癌，无临床复发证据。最初的胃活检雌激素和孕激素受体均为阴性。D2全胃切除术后的组织病理学报告为T4 N3 Mx。大体囊肿病液体蛋白免疫组化呈阳性，提示为转移性乳腺癌。第二例患者为一名61岁女性，在最初治疗乳腺癌14年后出现近端胃印戒腺癌，随后出现骨和胸膜转移复发。在该病例中，最初的胃活检雌激素和孕激素受体均为阳性；随后的检查发现广泛转移，未进行手术。
对于有乳腺癌病史的患者，当出现新的胃肠道症状或诊断为明显的原发性胃癌时，应高度怀疑胃可能发生乳腺癌转移。对胃活检进行完整的组织病理学和免疫组化分析，并与原乳腺癌病理进行比较很重要。
