Schwarz R E, Klimstra D S, Turnbull A D
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Am J Gastroenterol. 1998 Jan;93(1):111-4. doi: 10.1111/j.1572-0241.1998.111_c.x.
Seven patients with metastatic breast cancer presenting as gastrointestinal primary are described. These included six gastric and one colonic lesions. None of the patients had known systemic metastases at the time of diagnosis. The mean age at presentation was 66.7 yr (range 55-78). Median interval between breast cancer and gastrointestinal metastasis diagnosis was 6 yr (range 0.25-12.5). Original breast cancer histology included infiltrating lobular cancer (n = 4), infiltrating ductal cancer (n = 1), and a mixed type (n = 2). All patients with gastric involvement presented with epigastric pain and early satiety; the patient with colonic involvement had heme-positive stool. In three cases of gastric tumor and the one case of colonic tumor presentation, a definitive diagnosis of metastatic breast cancer was only confirmed after surgical resection of a presumed primary gastric or colonic malignancy. In the other three cases, pathological diagnostic confirmation was obtained through endoscopic biopsies and comparison to breast biopsy material, and operative treatment was avoided in favor of systemic cytotoxic therapy. The diagnosis was confirmed through similarities between mammary and gastric histopathology with regard to growth pattern, hormone receptor status, or gross cystic disease fluid protein. A high level of suspicion for metastatic breast cancer and a detailed pathological analysis will help avoid unnecessary surgical treatment in patients with a history of mammary carcinoma presenting with a newly diagnosed gastrointestinal neoplasm.
本文描述了7例以胃肠道原发性肿瘤表现的转移性乳腺癌患者。其中包括6例胃部病变和1例结肠病变。所有患者在诊断时均无已知的全身转移。患者就诊时的平均年龄为66.7岁（范围55 - 78岁）。乳腺癌与胃肠道转移诊断之间的中位间隔时间为6年（范围0.25 - 12.5年）。原发乳腺癌组织学类型包括浸润性小叶癌（4例）、浸润性导管癌（1例）和混合型（2例）。所有胃部受累患者均表现为上腹部疼痛和早饱；结肠受累患者有便血阳性大便。在3例胃部肿瘤和1例结肠肿瘤病例中，仅在手术切除疑似原发性胃部或结肠恶性肿瘤后才确诊为转移性乳腺癌。在其他3例中，通过内镜活检并与乳腺活检材料进行比较获得病理诊断证实，避免了手术治疗，而采用全身细胞毒性治疗。通过乳腺和胃部组织病理学在生长模式、激素受体状态或大体囊肿病液蛋白方面的相似性证实了诊断。对于有乳腺癌病史且新诊断为胃肠道肿瘤的患者，高度怀疑转移性乳腺癌并进行详细的病理分析将有助于避免不必要的手术治疗。
