Tang Jie, Zhao Guang-Xi, Deng Shuang-Shuang, Xu Ming
Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.
Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.
World J Gastrointest Oncol. 2021 Feb 15;13(2):147-156. doi: 10.4251/wjgo.v13.i2.147.
Breast cancer is the most common tumor in women, and about one-third of cases develop metastatic disease. However, metastatic breast cancer rarely invades the common bile duct (CBD) directly without involving the liver, and involvement of the gastrointestinal tract is rare. Cases of such metastases pose a particular diagnostic challenge.
A 55-year-old female presented to the Department of Gastroenterology with complaint of a 2 mo history of right upper abdominal pain accompanied by pain in the right back, aggravated after eating greasy diet. The patient had received a diagnosis of breast cancer 3 years prior. Physical examination showed obvious superficial protuberant erythema on the left neck and chest skin, with slight tenderness and burning sensation. Endoscopic retrograde cholangiopancre-atography showed an obstruction at the end of the CBD. Histopathology of the CBD and symptomatic skin biopsies showed positivity for cytokeratin 7 and trans-acting T-cell-specific transcription factor breast cancer biomarkers. A cancer embolus was also found in the skin vasculature. Accordingly, the diagnosis of breast cancer metastases to the skin and biliary ducts was made. A plastic biliary sent was placed, which relieved the right upper abdominal pain and protected against unnecessary hepatectomy surgery.
Although rare, biliary metastasis should be considered in patients with bile duct stenosis and a history of breast cancer.
乳腺癌是女性最常见的肿瘤，约三分之一的病例会发展为转移性疾病。然而，转移性乳腺癌很少直接侵犯胆总管（CBD）而不累及肝脏，且胃肠道受累情况罕见。此类转移病例带来了特殊的诊断挑战。
一名55岁女性因右上腹疼痛伴右背部疼痛2个月就诊于消化内科，进食油腻饮食后加重。该患者3年前被诊断为乳腺癌。体格检查显示左颈部和胸部皮肤有明显的浅表隆起红斑，有轻微压痛和烧灼感。内镜逆行胰胆管造影显示胆总管末端梗阻。胆总管和有症状皮肤活检的组织病理学显示细胞角蛋白7和反式作用T细胞特异性转录因子乳腺癌生物标志物呈阳性。在皮肤血管中也发现了癌栓。因此，诊断为乳腺癌转移至皮肤和胆管。放置了塑料胆管支架，缓解了右上腹疼痛，并避免了不必要的肝切除手术。
尽管罕见，但对于有胆管狭窄和乳腺癌病史的患者，应考虑胆管转移。
