Hussain Tasadooq, Elahi Bilal, McManus Penelope, Mahapatra Tapan, Kneeshaw Peter John
University of Hull; Hull York Medical School, Castle Hill Hospital, Hull, UK.
J Med Case Rep. 2012 Aug 7;6:232. doi: 10.1186/1752-1947-6-232.
Gastrointestinal tract soft tissues metastasis is a well-known occurrence with invasive lobular breast cancer subtypes. Gastric involvement is more common, with reports of both diffuse and localized involvements. Usually, a gastric localized involvement presents as wall thickening with an appearance similar to that of a gastrointestinal stromal tumour; rarely does a localized metastatic deposit grow aggressively to present as a large tumour causing obstructive symptoms. Our case highlights one such unusual presentation in a patient presenting with non-specific gastrointestinal symptoms. To the best of our knowledge, there have been no previous reports on a similar presentation occurring from a localized metastasis.
A 65-year-old Caucasian woman awaiting an outpatient oral gastroduodenoscopy for symptoms of intermittent vomiting, epigastric pains and weight loss of six weeks' duration presented acutely with symptoms of haematemesis and abdominal distension. An initial contrast-enhanced computed tomography scan showed a grossly dilated stomach with a locally advanced stenosing tumour mass at the pylorus. Our patient had a history of left mastectomy and axillary clearance followed by adjuvant endocrine therapy for an oestrogen receptor- and progesterone receptor-positive, grade 2, invasive lobular breast cancer. The oral gastroduodenoscopy confirmed the computed tomography findings; biopsies of the pyloric mass on immunohistochemistry stains were strongly positive for pancytokeratin and gross cystic disease fluid proteins, consistent with an invasive lobular breast cancer metastasis. She received a palliative gastrojejunal bypass and her adjuvant endocrine treatment was switched over to exemestane.
Our case highlights the aggressive behaviour of a localized gastric metastasis that is unusual and unexpected. Gastrointestinal symptomatology can be non-specific and, at times, non-diagnostic on conventional mucosal biopsies. A high index of clinical suspicion in patients with a previous history of invasive lobular breast cancer can aid in an early diagnosis and treatment. A combined treatment approach with chemoendocrine therapies achieves remission and improves patient survival.
胃肠道软组织转移是浸润性小叶癌亚型中一种常见的情况。胃部受累更为常见，有弥漫性和局限性受累的报道。通常，胃部局限性受累表现为胃壁增厚，外观类似于胃肠道间质瘤；局限性转移灶很少会迅速生长形成大肿瘤并导致梗阻症状。我们的病例突出了一名出现非特异性胃肠道症状患者的这种不寻常表现。据我们所知，此前尚无关于局限性转移导致类似表现的报道。
一名65岁的白种女性，因持续六周的间歇性呕吐、上腹部疼痛和体重减轻症状等待门诊口服胃十二指肠镜检查，却突然出现呕血和腹胀症状。最初的增强计算机断层扫描显示胃明显扩张，幽门处有一个局部进展性狭窄肿瘤块。我们的患者有左侧乳房切除术和腋窝清扫病史，随后接受了雌激素受体和孕激素受体阳性、2级浸润性小叶癌的辅助内分泌治疗。口服胃十二指肠镜检查证实了计算机断层扫描的结果；幽门肿块活检的免疫组织化学染色显示全细胞角蛋白和巨大囊肿病液体蛋白呈强阳性，与浸润性小叶癌转移一致。她接受了姑息性胃空肠吻合术，辅助内分泌治疗改为依西美坦。
我们的病例突出了局限性胃转移的侵袭性，这种情况不常见且出乎意料。胃肠道症状可能是非特异性的，有时常规黏膜活检无法诊断。对有浸润性小叶癌病史的患者保持高度的临床怀疑有助于早期诊断和治疗。化疗内分泌联合治疗方法可实现缓解并提高患者生存率。
