Clavien P A, Laffer U, Torhost J, Harder F
Department of Surgery, University Hospital, Basle, Switzerland.
Eur J Surg Oncol. 1990 Apr;16(2):121-6.
Of 1192 patients treated for breast cancer, four had extrahepatic gastro-intestinal metastases as first clinical manifestation of the tumour dissemination. One woman presented with gastric metastases mimicking a linitis plastica. Another had metastases localized to the rectum also mimicking a linitis plastica. Two women had peritoneal and retroperitoneal metastases that caused, in one case, a right hydronephrosis. Histology of the four primary tumours showed invasive lobular carcinoma (ILC) mixed with invasive ductal carcinoma in two. However, ILC exclusively was found at the site of the gastro-intestinal metastases involving the serosal layer (two cases) and extending to the submucosa (one case) or to the mucosal stroma (one case). Thus, when a women with previous history of invasive lobular breast cancer experiences gastro-intestinal symptoms, particular attention should be paid to the large and deep biopsy of lesions to ascertain the histological type and whether oestrogen or progesterone receptors differ from those of the primary breast lesion. Since survival is extremely variable (one woman is alive 7 years after the discovery of gastro-intestinal metastases), treatment including surgery, hormonal manipulation and chemotherapy with the expectation of a cure is often justifiable, particularly if no other extensive metastases are present.
在1192例接受乳腺癌治疗的患者中，有4例出现肝外胃肠道转移，这是肿瘤播散的首发临床表现。1例女性表现为酷似皮革胃的胃转移。另1例直肠转移也酷似皮革胃。2例女性有腹膜和腹膜后转移，其中1例导致右肾积水。4例原发性肿瘤的组织学检查显示，2例为浸润性小叶癌（ILC）与浸润性导管癌混合。然而，在累及浆膜层（2例）并延伸至黏膜下层（1例）或黏膜基质（1例）的胃肠道转移部位仅发现了ILC。因此，当有浸润性小叶乳腺癌病史的女性出现胃肠道症状时，应特别注意对病变进行大而深的活检，以确定组织学类型以及雌激素或孕激素受体是否与原发性乳腺病变不同。由于生存率差异极大（1例女性在发现胃肠道转移后存活了7年），包括手术、激素治疗和化疗以期治愈的治疗方法往往是合理的，尤其是在没有其他广泛转移的情况下。
