Department of Gastroenterology, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan.
BreathMAT Lab, Pakistan Institute of Nuclear Science and Technology, Islamabad, Pakistan.
Women Health. 2021 Oct;61(9):867-871. doi: 10.1080/03630242.2021.1981516. Epub 2021 Sep 26.
Metastatic spread of invasive lobular breast carcinoma to stomach is rare especially before diagnosis of primary breast cancer. Incorrect diagnosis might result in delay of appropriate treatment for breast cancer. Recognition of this possibility enables better clinical management. A 62-year-old female presented with upper gastrointestinal symptoms and weight loss and was referred to a gastroenterologist for investigation. At the time of initial diagnosis of stomach cancer, patient was asymptomatic for breast cancer. Multiple gastric biopsies taken showed features suspicious of metastatic breast cancer. Consequently, the initial provisional diagnosis of stomach cancer changed into metastatic invasive lobular breast carcinoma. These findings were corroborated radiologically. The patient was treated with letrozole and zoledronic acid as first-line therapy for one year. Residual metastatic breast cancer was present in the gastric mucosa. The patient was treated with endocrine therapy containing ribociclib and treatment was ineffective confirmed by PET-CT scan. But her symptoms have resolved completely despite her presentation with stage IV. We present rare case of initial presentation of gastric metastasis before diagnosis of a primary invasive lobular breast carcinoma. Correct diagnosis and appropriate treatment were accomplished through initial clinical suspicion, accurate histological examination, and endoscopy together with analysis of disease-specific biomarkers.
浸润性小叶乳腺癌转移至胃的情况较为罕见，尤其是在原发性乳腺癌诊断之前。错误的诊断可能会导致乳腺癌的治疗延误。认识到这种可能性可以更好地进行临床管理。一名 62 岁女性因上消化道症状和体重减轻就诊，并被转介给胃肠病学家进行检查。在最初诊断为胃癌时，患者没有乳腺癌的症状。多次胃活检显示出疑似转移性乳腺癌的特征。因此，最初的暂定诊断为胃癌转变为转移性浸润性小叶乳腺癌。这些发现得到了影像学的证实。患者接受了来曲唑和唑来膦酸作为一线治疗方案，治疗了一年。胃黏膜仍存在转移性乳腺癌。患者接受了含有瑞博西林的内分泌治疗，但 PET-CT 扫描证实治疗无效。但尽管患者处于 IV 期，她的症状已完全缓解。我们提出了一个罕见的病例，即胃转移在原发性浸润性小叶乳腺癌诊断之前首次出现。通过最初的临床怀疑、准确的组织学检查和内镜检查以及疾病特异性生物标志物的分析，完成了正确的诊断和适当的治疗。
