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Review
. 2024 Jun 13;60(6):980.
doi: 10.3390/medicina60060980.

Gastric Metastasis Mimicking Early Gastric Cancer from Invasive Ductal Carcinoma of the Breast: Case Report and Literature Review

Kwon Cheol Yoo  1   2 , Dae Hoon Kim  1   2 , Sungmin Park  1   2 , HyoYung Yun  1   2 , Dong Hee Ryu  1   2 , Jisun Lee  3   4 , Seung-Myoung Son  5   6
Affiliations
Review

Gastric Metastasis Mimicking Early Gastric Cancer from Invasive Ductal Carcinoma of the Breast: Case Report and Literature Review

Kwon Cheol Yoo et al. Medicina (Kaunas). .

Abstract

Backgound and Objectives: Gastric metastasis from invasive ductal breast cancer (BC) is rare. It mainly occurs in patients with lobular BC. The occurrence of multiple metastases is typically observed several years after the primary diagnosis. Endoscopic findings of gastric metastasis of the BC were usually the linitis plastic type. Case presentation: A 72-year-old women who underwent right modified radical mastectomy (MRM) 10 month ago was referred after being diagnosed with early gastric cancer (EGC) during systemic chemotherapy. EGC type I was found at gastric fundus, and pathologic finding showed poorly differentiated adenocarcinoma. Metachronous double primary tumor EGC was considered. Management and Outcome: A laparoscopic total gastrectomy was performed, and postoperative pathology revealed submucosa invasion and two lymph node metastases. A pathologic review that focused on immunohistochemical studies of selected antibodies such as GATA binding protein 3 (GATA3), gross cystic disease fluid protein-15 (GCDFP-15), cytokeratin 7 (CK7) was performed again, comparing previous results. As a result, gastric metastasis from BC was diagnosed. After totally laparoscopic total gastrectomy, palliative first-line chemotherapy with paclitaxel/CDDP was performed. Two months after gastrectomy, she was diagnosed with para-aortic lymph node metastasis and multiple bone metastases. She expired six months after gastrectomy. Conclusions: Gastric metastasis from invasive ductal carcinoma of the breast, which is clinically manifested as EGC, is a very rare condition. If there is a history of BC, careful pathological review will be required.

Keywords: cytokeratin 7; gastric metastasis; immunohistochemistry; invasive ductal carcinoma of breast.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) The breast cancer consisted of solid nests or cords of tumor cells, which was consistent with the diagnosis of invasive ductal carcinoma (H-E staining, ×200). (B) Endoscopy showed about 1 cm sized elevated out in posterior wall of gastric fundus, (white arrow). (C) The biopsy specimen of the gastric tumor showed poorly differentiated carcinoma with no glandular differentiation (H-E staining, ×100).
Figure 2
Figure 2
Immunohistochemical staining for GATA3 (A) and GCDFP-15 (B) was negative in the breast cancer specimen (×200). GATA3 (C) and GCDFP-15 (D) immunostaining were also negative in the biopsy specimen of the gastric tumor (×200).
Figure 3
Figure 3
(A) The gastrectomy specimen showed tumor cells with histopathologic features identical to those of carcinoma of the breast, which invaded the submucosa of the stomach (×40). The cytokeratin 7 immunostaining showed diffuse and strong positivity in both gastric cancer (B) and breast cancer (C).
Figure 4
Figure 4
(A) PET-CT performed two months after total gastrectomy showed para-aortic lymph node metastasis (yellow arrow); (B) PET-CT also showed multiple bone metastases (yellow arrow).
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