Falco Giuseppe, Mele Simone, Zizzo Maurizio, Di Grezia Graziella, Cecinato Paolo, Besutti Giulia, Coiro Saverio, Gatta Gianluca, Vacondio Rita, Ferrari Guglielmo
Department of Oncology and Advanced Technologies, Breast Surgery Unit, IRCSS Santa Maria Nuova Hospital, Reggio Emilia Department of Oncology and Advanced Technologies, Surgical Oncology Unit, IRCCS Santa Maria Nuova Hospital, Reggio Emilia Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena Radiology Department, Criscuoli Hospital, Sant' Angelo dei Lombardi, Avellino Department of Oncology and Advanced Technologies, Gastroenterology-Digestive Endoscopy Unit, IRCCS Santa Maria Nuova Hospital, Reggio Emilia Department of Imaging and Medicine of Laboratory, Radiology Unit, IRCCS Santa Maria Nuova Hospital, Reggio Emilia Radiology Department, "Luigi Vanvitelli" University of Campania, Naples, Italy.
Medicine (Baltimore). 2018 May;97(21):e10888. doi: 10.1097/MD.0000000000010888.
Metastatic spread in invasive lobular carcinoma (ILC) of breast mainly occurs in bones, gynecological organs, peritoneum, retroperitoneum, and gastrointestinal (GI) tract. Metastases to the GI tract may arise many years after initial diagnosis and can affect the tract from the tongue to the anus, stomach being the most commonly involved site. Clinical presentations are predominantly nonspecific, and rarely asymptomatic. CEA, CA 15-3, and CA 19-9 may be informative for symptomatic patients who have had a previous history of breast cancer.
We introduce the case of asymptomatic colonic metastasis from breast carcinoma in a 67-year-old woman followed-up for Luminal A ILC. Diagnosis was performed through positron emission tomography/computed tomography (PET/CT) scan and contrast-enhancement spectral mammography (CESM), steering endoscopist to spot the involved intestinal tract and in ruling out further dissemination in the breast parenchyma.
In colonic metastases, tumor markers might not be totally reliable. In asymptomatic cases, clinical conditions might be underappreciated, missing local or distant recurrence. CT and PET/CT scan might be useful in diagnosing small volume diseases, and steering endoscopist toward GI metastasis originating from the breast. CESM represents a tolerable and feasible tool that rules out multicentricity and multifocality of breast localization. Moreover, particular patients could tolerate it better than magnetic resonance imaging (MRI).
乳腺浸润性小叶癌（ILC）的转移主要发生在骨骼、妇科器官、腹膜、腹膜后和胃肠道（GI）。胃肠道转移可能在初次诊断多年后出现，可累及从舌头到肛门的整个消化道，其中胃是最常受累的部位。临床表现主要是非特异性的，很少有无症状的情况。癌胚抗原（CEA）、糖类抗原15-3（CA 15-3）和糖类抗原19-9（CA 19-9）对于有乳腺癌病史的有症状患者可能具有参考价值。
我们介绍了一名67岁患有管腔A型ILC的女性患者，其出现无症状性结肠癌转移的病例。通过正电子发射断层扫描/计算机断层扫描（PET/CT）和对比增强光谱乳腺造影（CESM）进行诊断，引导内镜医师发现受累肠道，并排除乳腺实质内的进一步扩散。
在结肠癌转移中，肿瘤标志物可能并不完全可靠。在无症状病例中，临床情况可能未得到充分认识，从而遗漏局部或远处复发。CT和PET/CT扫描可能有助于诊断小体积疾病，并引导内镜医师发现源自乳腺的胃肠道转移。CESM是一种可耐受且可行的工具，可排除乳腺定位的多中心性和多灶性。此外，特定患者对它的耐受性可能优于磁共振成像（MRI）。
