Ngatuvai Micah, Pasarin Anthony, Gabra Abanoub, Pidhorecky Ihor
Orthopedics, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA.
Orthopedics, Texas Tech University Health Sciences Center, El Paso, El Paso, USA.
Cureus. 2024 Nov 23;16(11):e74308. doi: 10.7759/cureus.74308. eCollection 2024 Nov.
Invasive lobular breast cancer (ILBC) is a common cause of breast cancer. Prognosis is dependent on many factors such as metastasis location and hormone receptor positivity. A 59-year-old postmenopausal African-American female who was referred to our clinic in May of 2022 presented with a suspicious small bowel lesion seen on surveillance imaging. The patient was diagnosed 15 years prior, with hormone receptor triple positive ILBC of the left breast, T1N2M0. In March of 2021, the patient was admitted to the hospital for rectal bleeding and was also found to have an elevated carcinoembryonic antigen (CEA) level. Computed tomography of the abdomen and pelvis was performed, which revealed a 4 cm segment of proximal ileum that was indeterminate for inflammation, neoplasm, or focal ischemia. The patient ultimately agreed to proceed with a diagnostic laparoscopy to further identify this area and underwent a small bowel resection. The final pathology of this specimen revealed a poorly differentiated, diffuse-type carcinoma with a focal mucinous matrix. The tumor involved the submucosa, serosa, and pericolonic adipose tissue. The morphology was consistent with metastatic carcinoma originating from ILBC. The hormone receptors for this specimen revealed estrogen-receptor (ER) negative, progesterone-receptor (PR) negative, and human epidermal growth factor receptor-2 (HER-2) negative. Lobular breast cancer metastasis to the small bowel as well as triple positive to triple negative conversion is exceedingly rare. The recurrence and metastasis of breast cancer are considerably high and the survival rate for these individuals has shown little improvement throughout the last decade. Defining relevant prognostic markers is crucial for improved management with known metastasis and triple negative receptors.
浸润性小叶乳腺癌（ILBC）是乳腺癌的常见病因。预后取决于许多因素，如转移部位和激素受体阳性情况。一名59岁的绝经后非裔美国女性于2022年5月转诊至我院，其在监测影像上发现有可疑的小肠病变。该患者15年前被诊断为左乳激素受体三阳性ILBC，T1N2M0。2021年3月，患者因直肠出血入院，还发现癌胚抗原（CEA）水平升高。进行了腹部和盆腔计算机断层扫描，结果显示一段4厘米长的回肠近端，炎症、肿瘤或局灶性缺血情况不明。患者最终同意进行诊断性腹腔镜检查以进一步明确该区域，并接受了小肠切除术。该标本的最终病理显示为低分化弥漫型癌，伴有局灶性黏液基质。肿瘤累及黏膜下层、浆膜层和结肠周围脂肪组织。形态学与源自ILBC的转移性癌一致。该标本的激素受体显示雌激素受体（ER）阴性、孕激素受体（PR）阴性和人表皮生长因子受体2（HER-2）阴性。小叶乳腺癌转移至小肠以及从三阳性转变为三阴性极为罕见。乳腺癌的复发和转移率相当高，在过去十年中这些患者的生存率几乎没有改善。确定相关的预后标志物对于改善已知转移和三阴性受体患者的管理至关重要。
