Gangireddy Mounika, Shrimanker Isha, Saintelia Sandy, Gomez Janet, Peroutka Kathryn A
Internal Medicine, UPMC Pinnacle, Harrisburg, USA.
Hematology-Oncology, Andrews and Patel Associates, Harrisburg, USA.
Cureus. 2019 Nov 19;11(11):e6199. doi: 10.7759/cureus.6199.
Breast cancer is the most common cancer in women. The common sites of metastasis include the lungs, liver, and, infrequently, the gastrointestinal (GI) tract. A 72-year-old Caucasian female presented to the hospital with nausea and vomiting, diarrhea, intermittent abdominal pain, and unintentional weight loss. She had had a past medical history of bilateral lobular breast carcinoma and severe iron-deficiency anemia treated with iron transfusions. On arrival, the examination was significant for hypotension and pallor. Laboratory investigations revealed abnormal liver enzymes and raised tumor markers Ca-125 and carcinoembryonic antigen. Imaging studies established a diagnosis of distal small bowel obstruction. The surgical intervention showed the presence of a small bowel tumor, the biopsy findings of which were consistent with metastatic breast cancer, with ER and PR positive but HER-2 negative. She was managed with a selective estrogen receptor degrader and CDK4/6 inhibitor and has been in remission since. Metastasis to the small bowel from the breast is a very rare occurrence. Clinicians should thus maintain a modest amount of suspicion when encountering an uncommon GI presentation of primary breast malignancy. We describe the case of metastatic breast cancer with an atypical GI presentation.
乳腺癌是女性中最常见的癌症。常见的转移部位包括肺、肝，很少转移至胃肠道（GI）。一名72岁的白人女性因恶心、呕吐、腹泻、间歇性腹痛和非故意体重减轻入院。她既往有双侧小叶乳腺癌病史，曾因严重缺铁性贫血接受输血治疗。入院时，检查发现有低血压和面色苍白。实验室检查显示肝酶异常，肿瘤标志物Ca-125和癌胚抗原升高。影像学检查确诊为远端小肠梗阻。手术干预发现有小肠肿瘤，活检结果与转移性乳腺癌一致，雌激素受体（ER）和孕激素受体（PR）阳性，但人表皮生长因子受体2（HER-2）阴性。她接受了选择性雌激素受体降解剂和细胞周期蛋白依赖性激酶4/6（CDK4/6）抑制剂治疗，此后一直处于缓解状态。乳腺癌转移至小肠非常罕见。因此，临床医生在遇到原发性乳腺癌不常见的胃肠道表现时应保持一定程度的怀疑。我们描述了一例具有非典型胃肠道表现的转移性乳腺癌病例。
