Nikkar-Esfahani A, Kumar Bhaskar G, Aitken Douglas, Wilson Robert G
Department of Colorectal Surgery, James Cook University, Hospital, Middlesbrough, UK.
Case Rep Gastroenterol. 2013 Mar 7;7(1):106-11. doi: 10.1159/000348760. Print 2013 Jan.
Metastatic spread of breast carcinoma to the colon and rectum is rare. We report the case of a patient treated for lobular breast carcinoma presenting 17 years later with metastatic breast cancer of the colon. A 63-year-old lady with a past history of right-sided invasive lobular carcinoma of the breast presented with persistent diarrhoea. Colonoscopy with biopsies revealed a benign-looking stricture at the rectosigmoid junction. A CT scan of the abdomen and pelvis revealed a benign-looking stricture in keeping with a probable diverticular stricture. A Hartmann procedure was performed and histology revealed a metastatic lobular carcinoma with oestrogen and progesterone receptor-positive status. Treatment was commenced with letrozole and the patient remains well under clinical surveillance. In a patient with a history of breast carcinoma who presents with gastrointestinal symptoms the possibility of gastrointestinal tract spread should always be considered. Endoscopic diagnosis may be misleading with pathological diagnosis only being made following surgical resection. A history of breast carcinoma must be declared to the histopathologist following surgical resection so that an accurate diagnosis is made and appropriate treatment is commenced.
乳腺癌转移至结肠和直肠较为罕见。我们报告一例小叶性乳腺癌患者，17年后出现结肠转移性乳腺癌。一名63岁女性，既往有右侧乳腺浸润性小叶癌病史，现出现持续性腹泻。结肠镜检查及活检显示在直肠乙状结肠交界处有一个外观良性的狭窄。腹部和盆腔CT扫描显示一个外观良性的狭窄，可能为憩室性狭窄。行哈特曼手术，组织学检查显示为转移性小叶癌，雌激素和孕激素受体呈阳性状态。开始使用来曲唑治疗，患者在临床监测下情况良好。对于有乳腺癌病史且出现胃肠道症状的患者，应始终考虑胃肠道转移的可能性。内镜诊断可能会产生误导，只有在手术切除后才能做出病理诊断。手术切除后必须向组织病理学家声明乳腺癌病史，以便做出准确诊断并开始适当治疗。
