Breast cancer is one of the most common cancers afflicting women and
the second leading cause of cancer death [1]. About
60 % of patients have distant metastases at the time of
diagnosis. Diagnosis at an early stage increases survival rates. However, even
after a long disease-free interval, long-term survivors risk developing
metastatic tumors. Common sites of metastasis for breast cancer are bones,
lungs, the central nervous system, and the liver; gastrointestinal involvement
is rare [2]
[3]
[4]
[5]. There have been a few reports
of colonic metastasis of breast cancer, mostly in patients with disseminated
disease. Tohfe et al. [1], Law et al. [2], and Kilgore et al. [3] described
one case each, and Michalopoulos et al. [4] reported two
cases of breast cancer metastasis to the colon. We report a case of colonic
metastasis from breast cancer 7 years after mastectomy and chemotherapy.
A 74-year-old woman complained of weakness, anemia, intestinal blood
loss, and diarrhea. She had undergone right radical mastectomy followed by
chemotherapy for an infiltrating lobular breast tumor 7 years previously. The
workup, including a chest X-ray and computed tomography (CT) of the thorax,
abdomen, and pelvis, was normal. Serum levels of Ca 15 – 3
and CEA had gone up in the past month. Magnetic resonance imaging (MRI)
revealed thickness of the ascending colon and cecum wall with localized
enlarged lymph nodes. The patient had undergone colonoscopy 6 months previously
that revealed sigmoid diverticular disease and a sigmoid adenoma, which was
resected by mucosectomy. A new colonoscopy showed a stricture of the ascending
colon with a friable, ulcerated lesion, which was biopsied ([Figs. 1], [2]). Chromatoscopy
at high magnification showed the lesion to have a Vi pit pattern
according to Kudo’s classification ([Fig. 3]). The pathological evaluation of the tissue
using hematoxylin and eosin staining showed a poorly differentiated carcinoma
([Fig. 4 a]). Immunohistochemical staining
of the colon biopsy specimen showed surface epithelium with the lamina propria
infiltrated by tumor cells with abundant eosinophilic cytoplasm, many with
eccentric nuclei, intracytoplasmic lumina, and a signet-ring appearance. The
specimen tested positive for cytokeratin 7, estrogen receptor, and gross cystic
disease fluid protein 15 (GCDFP- 15)/Breast-2 protein, confirming it to be a
lobular breast carcinoma metastasis ([Fig. 4 b, c]). The patient is receiving
systemic chemotherapy preoperatively, as well as hormonal therapy, and is free
of symptoms, with no bleeding. Surgical treatment with a right extended
hemicolectomy is programmed after the chemotherapy has been completed.
Fig. 1 Colonoscopy in this
74-year-old woman showed irregular areas, nodulation, and ulceration in the
ascending colon.
Fig. 2 Chromatoscopy using
indigo carmine showed stricture of the ascending colon with a friable,
ulcerated lesion.
Fig. 3 Chromatoscopy at high
magnification showed the lesion to have a Vi pit pattern.
Fig. 4 a Hematoxylin and eosin
staining showed a poorly differentiated carcinoma (× 400).
b, c Immunohistochemical findings:
b estrogen receptor expression (× 400),
b gross cystic disease fluid protein 15 (GCDFP-15)
( × 400).
Endoscopy_UCTN_Code_CCL_1AD_2AB
