Gastrointestinal metastases in lobular breast cancer

Gastrointestinal metastases in lobular breast cancer,B. G. Taal,H. Boot,H. Peterse

Gastrointestinal metastases in lobular breast cancer   (Citations: 2)
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In a previous issue of Annals of Oncology, Bamias et al. re- ported the clinical case of a patient with rectal metastasis from lobular carcinoma of the breast (ILC) (1), In their summary of the literature, our series of 17 patients with colorectal metas- tases reported in 1992 is mentioned (2), However, five of the_ seven patients with rectal localisation selected for their table, suffered from additional infiltration of parts of the colon. In only two cases the rectum was the sole localisation of meta- static gastrointestinal involvement. We would like to add some more information on this subject to put it into perspective. One patient (50 years) developed diarrhoea caused by rectal stenosis 15 months after the diagnosis of locally advanced, lobular breast cancer. Endocrine treatment resulted in local response until death due to cerebral metastases 22 months later. The second patient (51 years) had diarrhoea and weight loss due to severe rectal obstruction, seven years after the treat- ment of ILC . Anthracyclin based chemotherapy resulted in a fair response of 9 months without the need for a colostomy. She eventually died 11 months after the diagnosis of rectal involvement due to diffuse peritoneal metastases. Solitary rectal metastasis of breast cancer is a rare condi- tion. In contrast, gastric involvement is a more common event, also prefentially occurring in ILC (3). In our series 36 of 51 patients with gastric metastases had ILC (4). Endoscopy showed mainly a diffuse linitis plastica-hke infiltration (57%), but also localised lesions (18%) such as ulceration and a polypoid mass, or stenosis due to extrinsic compression at the cardiac junction or the pylorus (25%) were present. Symptoms were non-specific: anorexia (71%), epigastric pain (53%) and vomiting (41%). The interval between primary breast cancer and intestinal complaints was prolonged (median 62 months, range 2-104). Metastases at other sites were present in 48 of 51 patients. The presenting site of metastatic disease was: skeleton (43%), stomach (27%), lung (8%) and liver (4%). The overall response to systemic therapy was fairly good with 46% despite the pre-treatment in half of the patients. Calculated from the detection of gastric metastases the median survival was 11 months with some long-term survivors leading to a two-year survival of 23%. Based on tumour invasion primarily in the subserosa, it not surprising that the endoscopic biopsies might be negative. In our series of gastric metastases endoscopic biopsies were positive in 35 patients; in six cases a second endoscopy re- vealed tumour cells, while in 10 patients with a negative histology the diagnosis was based on circumstantia l evidence from the characteristic endoscopic features along with metas- tases at other sites. Also, in the case of Bamias et al. repeated biopsies were helpful (1).
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