metastatic breast cance

Digestive metastasis of breast carcinoma: about a case

Summary
Metastases of breast cancer in the gastrointestinal tract are rare. Infiltration lobular carcinoma is the most incriminating type of histologic. We report the observation of a 55-year-old woman who was followed for left breast carcinoma and who presented after 8 years a metastatic gastric, colic, and peritoneal evolution.

Keywords
Breast cancer lobular carcinoma metastases of the gastrointestinal tract Gastrointestinal tract metastasis from a breast cancer: a case report
Abstract
Gastrointestinal tract metastases from primary breast cancer are rare. They are more common in the case of intralobular carcinoma type. We report a case of a 55 year old woman who was followed for a left breast carcinoma which presented after 8 years gastric, colonic and peritoneal metastases.

Summary breast cancer metastases at the level of the tract
Gastrointestinal tract are rare. Infiltration lobular carcinoma
Is the most incriminating type of histologic. We report
The observation of a woman aged 55 years followed
A left breast carcinoma and presented after 8 years
A gastric, colonic, and peritoneal metastatic evolution.
Key Words Breast Cancer · Lobular carcinoma ·
Metastases of the digestive tract
Abstract Gastrointestinal tract metastases from primary
Breast cancer are rare. They are more common in the case
of intralobular carcinoma type. We report a case of a 55 year
Old woman who was followed for a left breast carcinoma
Which presented after 8 years gastric, colonic and peritoneal
Metastases.
Breast Cancer keywords Lobular Gastrointestinal Tract
Metastases
Introduction
Breast cancer is the most common cancer in the
Women, both in incidence and in mortality. Forty for
Percent of female deaths before 65 years are attributable to the
Metastatic breast cancer [1]. Metastases are located
Mainly at the bone, lungs and liver levels
[2]. The gastrointestinal tract is a metastatic site
Rare for this type of cancer [3.4].
ObservationThis was a 55-year-old woman who was followed
Since 2003 for a left breast carcinoma classified
T2N1M0. She had undergone a left patey-type intervention.
The Anatomopathologic exam concluded with a carcinoma
Mixed duct and lobular of grade II according to
The classification of Scarff Bloom Richardson with an impairment
of a ganglion in 10 lymph nodes taken from the axillary drain.
Hormonal receptors were positive. The patient had
Had adjuvant treatment with 6 chemotherapy treatments from
Type FEC100 (5 fluoro-Uracil 500 mg/m2
/d J1, Epirubicin
100 mg/m2
Day J1, Cyclophosphamide 500 mg/m2
Day J1) and a
Locoregional radiotherapy at a dose of 50 Gy according to a
Conventional sprawl and splitting. She received a
Hormone therapy with tamoxifen.
After 32 months of tamoxifen, and with the onset of
Low abdominal pain, Abdominopelvic ultrasound
Was carried out showing a bilateral ovarian tumor.
The patient had had a hysterectomy with a salpingo
Bilateral. The Anatomopathologic review of the
Surgical part concluded with a bilateral ovarian metastasis
of a mixed breast carcinoma with hormonal receptors
Positive. The new extension balance had not been
showed other metastatic lesions. The patient had
6 Chemotherapy treatments of the docetaxel type and then received
Antiaromatase-type hormone therapy (Letrozole).
After 5 years of recoil, she presented Épigastralgies with
Transit disturbances. The examination showed a cutaneous jaundice,
A hepatomegaly and ascites of great abundance. A
Fibroscopy Œso-Gastro-duodenal and a colonoscopy showed
An infiltration process of the stomach and colon, the
Biopsy concluded with a gastric and colonic metastasis of a
Infiltration lobular carcinoma (CLI) of the breast with receptors
Positive hormones in the immunohistochemical study.
cytological examination of the ascites fluid concluded with a
peritoneal infiltration by breast carcinoma. A
J. Faulkner (*) · O. Ben Amor · N. Thao · A. Kanwar · Mr. Fox
Medical Oncology Service,
CHU Habib Bourguiba, 3029 Sfax, Tunisia
E-mail: feki_jihene@yahoo.fr
T. Boudawara
Pathology Service,
CHU Habib Bourguiba, 3029 Sfax, Tunisia
J. Daoud
Radiotherapy Service,
CHU Habib Bourguiba, 3029 Sfax, Tunisia
J. Afr. Hépatol. Gastroentérol. (2012) 6:231-233
DOI 10.1007/s12157-012-0399-Y
Thoraco-abdominal and pelvic tomography showed a
Pleural effusion, a nodular hepatomegaly
and an intra-abdominal effusion of great abundance
With the infiltration of mesenteric fat and the presence
of Adenopathies Cœliomésentérique and retroperitoneal.
The evolution was marked by the rapid progression of the
Illness and death after 1 month.
Discussion
In breast cancer, the occurrence of metastatic lesions
At the digestive level is rare. It is the second
This type of metastases after melanoma [3].
In our observation, it was an association of
Metastases of the gastrointestinal tract with peritoneal impairment. There
Had two digestive locations, one gastric and the other
Colic.
In a series published in 1993 conducted over 18 years, Borst
et al. [5] Report 17 cases of metastases at the tube level
Digestive among 2500 patients followed for a carcinoma
Metastatic breast is a frequency of less than
1% of cases [5]. McLemore el al . [6] reported in 2005,
In a series of the Mayo Clinic concerning 12001 patients
With metastatic breast cancer, metastasis
Digestive in 73 cases (i.e. 0.6%). These were 23 cases
of metastasis in the digestive tract and 32 cases of
Peritoneal carcinomatosis. Only eighteen cases had a
Reaching the gastrointestinal tract with an associated peritoneal carcinomatosis
(i.e. 0.15%) [6].
The metastases of the digestive tract mainly concerned
stomach and small intestine and less frequently the
Colon and rectum [7]. In the Mayo Clinic series [6],
Among the 23 cases of metastasis in the digestive tract,
The stomach occupied the first site with 28%, followed by the intestine
(19%), Colon and rectum (45%) and esophagus
8 [6].
Digestive metastases of breast cancer are more common
In the autopsy series with a frequency that
Ranged from 6 to 35% according to the series [7]. This may be due to
Often difficult to diagnose this type of injury because of the
Of the non-specific clinical presentation and the appearance
Of this type of metastasis [3.8].
In fact, the delay in the onset of a digestive metastasis
Ranged from 2 months to 32.8 years depending on the series and cases reported
[9]. This period was 8 years in our case.
The diagnosis of digestive metastasis is difficult. The presentation
Clinic is often non-specific. The Symptoms
Can vary from simple nausea, vomiting,

Digestive hemorrhage, Épigastralgie and weight loss at a
Abdominal mass or ascites [8-11]. These symptoms may
To other digestive pathologies or can be
Be linked to liver metastasis or syndromes
Paraneoplastic such as secondary hypercalcemia to
Bone metastases [8-10]. An endoscopy with
Biopsy for a anatomopathologic examination with a
Immunohistochemical study of hormonal receptors is
Therefore necessary to reattach the lesions
To its mammary origin [11]. Our patient has
Had a digestive endoscopy with biopsies whose examination
Anatomopathologic confirmed the diagnosis. However
Digestive endoscopy and biopsies can be negative
In more than 50% of cases [3.7].
Our patient had mixed-type infiltration carcinoma.
She presented a bilateral ovarian metastasis of a carcinoma
Mixed-type filter followed 5 years later by
Digestive metastasis of the lobular component. The CLI
is most often implicated (80% of cases) in metastases
Digestive Although it is only 4 to 10% of the
breast cancers [3.10]. It was also reported that even
In patients with infiltration breast cancer
The Lobular component is the one that
Provides digestive and gynecological metastasis [7]. The
CLI gives more frequently than ductal carcinoma
Infiltrating metastases at the level of peritoneum, retroperitoneal tumor,
The digestive tract, bone marrow and the
Level of gynecological organs [12]. The more affinity
Marked CLI for digestive and gynecological locations
Can be attributed to the loss of expression of the
Molecule E-Cadherin, involved in the mechanisms of
cell adhesion [3.11]. Digestive metastases are
Rarely isolated and often reported as part of a
Disseminated disease [3.4]. Our patient had a
Metastatic hepatic scalability.
Palliative chemotherapy with or without targeted therapy
Hormone therapy is the treatment of choice in the event
of a disseminated disease [2, 9,11]. Surgery keeps a
Limited role in emergency situations such as perforation or
occlusion [2.9]. In the case of isolated colonic metastasis,
Surgical resection should be considered with a treatment
Associated systemic [4, 7.9].
The digestive impairment during the evolution of carcinoma
Breast makes the prognosis dark despite a
Multidisciplinary load with a median of survival does
Not more than a few months [2.3].

Conclusion
Metastases of breast cancer in the digestive tract
And at the peritoneal level are rare. They are more frequent
In case of infiltration lobular carcinoma. The occurrence of
Digestive history in a patient with a background
Breast cancer should evoke the possibility of metastasis
The digestive level even in the absence of other sites