Zhao Qingmiao, Dou Lizhou, Feng Xiaolong, Wang Guiqi, He Shun
Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2025 May 22;15:1573163. doi: 10.3389/fonc.2025.1573163. eCollection 2025.
Breast cancer (BC) is the second leading cause of cancer-related death in women, with mortality primarily associated with metastasis. Although gastric metastasis is rare, there are still case reports in the literature. Clinical symptoms of gastric metastasis from BC are often nonspecific, and endoscopic presentations are heterogeneous. Distinguishing between primary and metastatic tumors is important and challenging for the endoscopist. Herein, we report a case of gastric metastasis occurring 4 years after BC surgery. The timeline is as follows. In 2019, the 60-year-old woman received neoadjuvant chemotherapy followed by left breast radical surgery and endocrine therapy with targeted treatment. In 2022 (3 years post-surgery), left axillary metastasis was diagnosed, requiring excision of a skin mass. In 2023 (4 years post-surgery), she presented with upper abdominal pain and acid reflux, and gastroscopy revealed a superficial flat lesion in the gastric antrum. Immunohistochemical (IHC) staining suggested the possibility of poorly differentiated adenocarcinoma. Contrast-enhanced computed tomography (CT) revealed focal abnormal enhancement of the gastric antrum without evidence of distant metastasis. Since endoscopic, imaging, and IHC staining findings did not clearly suggest BC metastasis, and considering the patient's history of BC and overall condition, she underwent endoscopic submucosal dissection (ESD)-a procedure performed with both diagnostic and therapeutic intent. The postoperative pathology revealed metastatic invasive lobular carcinoma (ILC) of the breast. The ESD not only clarified the patients' diagnosis but also avoided unnecessary surgery for the patient. The patient remains alive under maintenance therapy. In summary, our case highlights the role of ESD, which was performed with both diagnostic and therapeutic intent-in managing gastric metastasis from BC, while underscoring the necessity of regular endoscopic surveillance post-mastectomy.
乳腺癌（BC）是女性癌症相关死亡的第二大主要原因，死亡率主要与转移有关。尽管胃转移很少见，但文献中仍有病例报告。BC胃转移的临床症状通常不具有特异性，内镜表现也多种多样。区分原发性和转移性肿瘤对内窥镜医师来说既重要又具有挑战性。在此，我们报告一例BC手术后4年发生胃转移的病例。时间线如下。2019年，这位60岁的女性接受了新辅助化疗，随后进行了左乳根治性手术以及内分泌治疗和靶向治疗。2022年（术后3年），诊断出左腋窝转移，需要切除皮肤肿物。2023年（术后4年），她出现上腹部疼痛和反酸，胃镜检查发现胃窦有一个浅表扁平病变。免疫组织化学（IHC）染色提示为低分化腺癌的可能性。对比增强计算机断层扫描（CT）显示胃窦局灶性异常强化，无远处转移证据。由于内镜、影像学和IHC染色结果均未明确提示BC转移，考虑到患者的BC病史和整体状况，她接受了内镜黏膜下剥离术（ESD）——一种兼具诊断和治疗目的的手术。术后病理显示为乳腺转移性浸润性小叶癌（ILC）。ESD不仅明确了患者的诊断，还避免了患者进行不必要的手术。患者在维持治疗下仍然存活。总之，我们的病例突出了ESD在诊断和治疗双重目的下管理BC胃转移中的作用，同时强调了乳房切除术后定期内镜监测的必要性。
