Bürgesser Maria Virginia, Calafat Patricia, Diller Ana
Naciones Unidas 346. Barrio Parque Vélez Sarsfield. Córdoba, Argentina.
Rev Fac Cien Med Univ Nac Cordoba. 2010;67(2):85-8.
Gastrointestinal metastases are rare. May occur years after initial diagnosis and its symptoms are nonspecific, delaying its correct diagnosis and aggravating its prognosis. The most common histological subtype is lobular breast carcinoma. We present a 75-year-old woman with history of left mastectomy six years ago by infiltrating lobular carcinoma. She was treated with tamoxifen for five years. At present, there was no evidence of disease. She attended the hospital for intestinal subocclusion, being admitted for study. A barium enema revealed multiple strictures of the large bowel and a colonoscopy revealed an impassable stricture in the rectum-sigma. Due to the severity of symptoms, underwent total colectomy. The suspected diagnosis was Crohn's disease. The surgical specimen showed multiple stenosis of the light, with thickened wall and mucosa with granulations. Microscopic examination showed transmural infiltration of colonic wall by malignant cells CK7 positive and ER positive. Breast infiltrating lobular carcinoma has more special tendency to affect the digestive tract, even many years after the diagnosis of the primary tumor. In front of a patient with history of breast cancer and gastrointestinal symptoms, its mandatory to consider gastrointestinal metastases, making differential diagnosis with inflammatory bowel disease, infections or primary tumors, as the therapeutic actions are different.
胃肠道转移瘤罕见。可在初次诊断数年之后发生，其症状不具特异性，会延误正确诊断并加重预后。最常见的组织学亚型为小叶型乳腺癌。我们报告一名75岁女性，6年前因浸润性小叶癌行左乳切除术。她接受了5年的他莫昔芬治疗。目前无疾病证据。她因肠道不全梗阻入院检查。钡剂灌肠显示大肠多处狭窄，结肠镜检查显示直肠-乙状结肠交界处有一处无法通过的狭窄。由于症状严重，患者接受了全结肠切除术。疑似诊断为克罗恩病。手术标本显示多处轻度狭窄，肠壁增厚，黏膜有颗粒。显微镜检查显示结肠壁有CK7阳性和ER阳性的恶性细胞透壁浸润。乳腺浸润性小叶癌更有特殊倾向累及消化道，甚至在原发性肿瘤诊断多年之后。面对有乳腺癌病史且出现胃肠道症状的患者，必须考虑胃肠道转移瘤，要与炎症性肠病、感染或原发性肿瘤进行鉴别诊断，因为治疗措施不同。
