Metastatic Invasive Lobular Carcinoma of Bilateral Breasts Presenting with an Abdominal Mass LCIS presenting with abdominal mass

Sze Yuen Lee (1), Yamunadevi Arunasalam (2), Mathias Premanand Ponniah (3), Noor Farrahin Sazale (4), Norly Salleh (5), Haryati Husin (6)
(1) Department of Radiology, Hospital Segamat, Johor, Malaysia, Malaysia,
(2) Department of Radiology, Hospital Segamat, Johor, Malaysia, Malaysia,
(3) Department of Surgery, Hospital Segamat, Johor, Malaysia, Malaysia,
(4) Department of Surgery, Hospital Segamat, Johor, Malaysia, Malaysia,
(5) Department of Surgery, Hospital Segamat, Johor, Malaysia, Malaysia,
(6) Department of Pathology, Hospital Pakar Sultanah Fatimah Muar, Johor, Malaysia, Malaysia

Abstract

Background: Breast cancer remains the most frequent malignancy in women, with the two most common histological subtypes of breast cancer being the invasive ductal carcinomas (IDC) and invasive lobular carcinomas (ILC). The most common sites of breast cancer metastases are the liver, lung, pleura, brain and bone. Gastrointestinal, peritoneal, gynaecological and renal metastases are less common, often masquerading as primary malignancies and causing diagnostic confusion, mostly occurring in ILC as compared to IDC.


Case Presentation: We report a case of a young woman presenting with an enlarging abdominal mass which was suspicious of a primary abdominal malignancy. Endoscopy and gastric biopsy revealed poorly differentiated carcinoma. On the top-most slices of her abdominal CT, bilateral enhancing breast lesions were detected, suspicious of metastases. Ultrasound and biopsy done for the breast lesions showed bilateral ILCs. Further staining of the gastric biopsy specimen confirmed the final diagnosis of gastric metastases from bilateral breast ILCs rather than a primary gastric tumour with breast metastases.


Conclusion: This case highlights how breast cancer metastases to the GI tract may mimic primary GI cancers as well as the importance of breast examination, family history, radiological and pathological examination in detecting the breast origin of advanced carcinomas. Awareness of the different patterns of metastatic spread of ILC and IDC is also important due to the infiltrating nature and non-specific imaging findings of these tumours, requiring a high index of suspicion from the surgeons, oncologists, radiologists and pathologists.

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References

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71(3):209–249. doi: 10.3322/caac.21660.

Chikarmane SA, Tirumani SH, Howard SA, Jagannathan JP, DiPiro PJ. Metastatic patterns of breast cancer subtypes: what radiologists should know in the era of personalized cancer medicine. Clin Radiol 2015;70(1):1–10. doi: 10.1016/j.crad.2014.08.015.

Gerratana L, Fanotto V, Bonotto M, Bolzonello S, Minisini AM, Fasola G, et al. Pattern of metastasis and outcome in patients with breast cancer. Clin Exp Metastasis 2015;32(2):125–133. doi: 10.1007/s10585-015-9697-2.

Mosiun JA, Idris MS bin, Teoh LY, Teh MS, Chandran PA, See MH. Gastrointestinal tract metastasis presenting as intussusception in invasive lobular carcinoma of the breast: A case report. Int J Surg Case Rep 2019;64:109–112. doi: 10.1016/j.ijscr.2019.10.003.

Ciulla A, Castronovo G, Tomasello G, Maiorana AM, Russo L, Daniele E, et al. Gastric metastases originating from occult breast lobular carcinoma: diagnostic and therapeutic problems. World J Surg Oncol 2008;6(1):78. doi: 10.1186/1477-7819-6-78.

Noor A, Lopetegui-Lia N, Desai A, Mesologites T, Rathmann J. Breast Cancer Metastasis Masquerading as Primary Colon and Gastric Cancer: A Case Report. Am J Case Rep 2020;21:e917376-1-e917376-5. doi: 10.12659/AJCR.917376.

Xu L, Liang S, Yan N, Zhang L, Gu H, Fei X, et al. Metastatic gastric cancer from breast carcinoma: A report of 78 cases. Oncol Lett 2017;14(4):4069–4077. doi: 10.3892/ol.2017.6703.

Nazareno J, Taves D, Preiksaitis H-G. Metastatic breast cancer to the gastrointestinal tract: a case series and review of the literature. World J Gastroenterol 2006;12(38):6219–6224. doi: 10.3748/wjg.v12.i38.6219.

Borst MJ, Ingold JA. Metastatic patterns of invasive lobular versus invasive ductal carcinoma of the breast. Surgery 1993;114(4):637–641; discussion 641-642.

Mathew A, Rajagopal PS, Villgran V, Sandhu GS, Jankowitz RC, Jacob M, et al. Distinct Pattern of Metastases in Patients with Invasive Lobular Carcinoma of the Breast. Geburtshilfe Frauenheilkd 2017;77(6):660–666. doi: 10.1055/s-0043-109374.

Johnson K, Sarma D, Hwang ES. Lobular breast cancer series: imaging. Breast Cancer Res 2015;17(1):94. doi: 10.1186/s13058-015-0605-0.

Arpino G, Bardou VJ, Clark GM, Elledge RM. Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res 2004;6(3):R149–R156. doi: 10.1186/bcr767.

Selinko VL, Middleton LP, Dempsey PJ. Role of sonography in diagnosing and staging invasive lobular carcinoma. J Clin Ultrasound JCU 2004;32(7):323–332. doi: 10.1002/jcu.20052.

Wong YM, Jagmohan P, Goh YG, Putti TC, Ow SGW, Thian YL, et al. Infiltrative pattern of metastatic invasive lobular breast carcinoma in the abdomen: a pictorial review. Insights Imaging 2021;12(1):181. doi: 10.1186/s13244-021-01120-4.

Parvaiz MA, Yang P, Razia E, Mascarenhas M, Deacon C, Matey P, et al. Breast MRI in Invasive Lobular Carcinoma: A Useful Investigation in Surgical Planning? Breast J 2016;22(2):143–150. doi: 10.1111/tbj.12566.

Montagna E, Pirola S, Maisonneuve P, De Roberto G, Cancello G, Palazzo A, et al. Lobular Metastatic Breast Cancer Patients With Gastrointestinal Involvement: Features and Outcomes. Clin Breast Cancer 2018;18(3):e401–e405. doi: 10.1016/j.clbc.2017.07.003.

Hong J, Kim Y, Cho J, Lim SW, Park SE, Kim HK, et al. Clinical features and prognosis of breast cancer with gastric metastasis. Oncol Lett 2019;17(2):1833–1841. doi: 10.3892/ol.2018.9754.

Sarfraz H, Chen D, Muhsen IN, Schwartz MR, Ogbonna M. Breast Cancer Metastasis Masquerading as a Primary Gynecological / Colonic Malignancy: A Rare Diagnostic Conundrum. Cureus 2020;12(4). doi: 10.7759/cureus.7806.

Fang C, Cao Y, Liu X, Zeng X-T, Li Y. Serum CA125 is a predictive marker for breast cancer outcomes and correlates with molecular subtypes. Oncotarget 2017;8(38):63963–63970. doi: 10.18632/oncotarget.19246.

Authors

Sze Yuen Lee
szeyuen@gmail.com (Primary Contact)
Yamunadevi Arunasalam
Mathias Premanand Ponniah
Noor Farrahin Sazale
Norly Salleh
Haryati Husin
1.
Lee SY, Arunasalam Y, Ponniah MP, Sazale NF, Salleh N, Husin H. Metastatic Invasive Lobular Carcinoma of Bilateral Breasts Presenting with an Abdominal Mass: LCIS presenting with abdominal mass. Arch Breast Cancer [Internet]. 2022 Oct. 27 [cited 2024 Feb. 28];10(1):86-92. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/620

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