Akademik Veri Yönetim Sistemi
15. Ulusal Radyasyon Onkolojisi Kongresi (UROK 2023), Antalya, Türkiye, 6 - 10 Aralık 2023, ss.176, (Özet Bildiri)
Background: Gastrointestinal system metastasis in breast cancer is rare (%418) and the most common sites are colon and rectum (%45) followed by stomach (%28). Due to the fact that patients with dyspeptic complaints typically receive symptomatic treatments or are treated for it as a side effect of cancer treatment, stomach metastases is frequently overlooked in these patients. Endoscopic evaluations are important at this stage. The development of linitis plastica, a frequent gastroscopy finding, makes the diagnosis susceptible to error if deep and numerous biopsies are not performed. In this case, we are presenting a patient who didnt have a history of cancer and diagnosed with breast cancer metastasis to the stomach during investigations for dyspeptic complaints.
Case Report: 70 years old patient with no personal or family history, when she admitted to the Internal Medicine Department with complaint of nause, a suspicious lesion in the corpus was observed in the endoscopy and biopsy was taken. Upon detection of acinar and trabecular tumoral infiltration in the biopsy specimen, advanced immunohistochemical staining was performed and the result was reported as invasive lobular carcinoma metastasis of the breast. Then in the breast ultrasonography (USG) a possible malignant lesion in the left breast and multiple lymphadenopathies in the left axilla and left subclavian region were detected. In addition to these findings, band-like satellite tumoral lesions were detected in the upper and lower outer quadrants of the left breast in breast MR. Tru-cut biopsy of the patient's breast resulted in invasive lobular carcinoma. PET/CT scan was performed for systemic staging and pathological uptakes in the area corresponding to the lesion identified in breast MRI and USG; lymph nodes in the common iliac and paraaortocaval areas, right of the cerebellum; a metastatic increase in gastric corpus wall thickness and multiple lytic metastasis in the skeletal system has been reported. Cranial MRI was requested after PET/ CT interpretation and multiple metastatic lesions were reported. After starting Palbociclib and Letrozole, the patient was referred for palliative radiotherapy and we administered 24 Gy/3fr stereotactic radiation therapy to the right cerebellum and frontal area. At the last follow up, 6 months later from radiation therapy, patients nause was reduced and lesions in MRI were stable.
Conclusion: Even though it is rare, breast cancer can metastasize to gastrointestinal system. Especially women over 40 years of age if biopsy is going to be taken it should be deep and multiple. Metastasis should not be missed in patients with signet ring cells in histological examination, advanced immunohistochemical examination should be performed. It should be kept in mind that concomitant distant metastases are also common in patients with gastric metastases of the breast, and further investigation should be performed.
Keywords: Unusual presentation, breast cancer, dyspeptic symptoms, gastric metastasis