Case report of gastric outlet obstruction from metastatic lobular breast carcinoma

BMC Gastroenterology

Jinhong Li¹  Zong Ming Chen¹  M. Joshua Shellenberger¹  Alexander H. Kim¹ 

[1] Geisinger Medical Center, 100 N. Academy Ave., Danville 17822, PA, USA

关键词: Abdominal pain;    Cancer;    Breast cancer;    Gastric outlet obstruction;   

Others  :  1234394
DOI  :  10.1186/s12876-015-0350-y

 received in 2015-02-18, accepted in 2015-09-16,  发布年份 2015

【 摘 要 】

Background

The most common malignancy to cause gastric outlet obstruction is primary gastric adenocarcinoma and it is followed by carcinoma of the pancreas and gallbladder. Herein, we report a case of gastric outlet obstruction secondary to metastatic lobular breast carcinoma.

Case presentation

Fifty-seven year old Caucasian female with recently diagnosed metastatic lobular breast carcinoma to skin was referred to gastroenterology for evaluation of dyspepsia and dysphagia. She has past medical history significant for acid reflux and Clostridium difficile colitis. Computed tomography of her abdomen showed diffused bowel wall thickening without evidence of bowel obstruction. Due to persistent abdominal pain, an upper endoscopy was performed. The upper endoscopy showed gastritis and gastric stenosis in the gastric antrum. These lesions were biopsied and dilated with a balloon dilator. The biopsy of the gastric antrum later showed a metastatic carcinoma of breast origin with typical tumor morphology and immune-phenotype.

Conclusions

Differentiating metastatic breast carcinoma from primary gastric adenocarcinoma cannot be done using histological examination alone. Immunohistochemistry is needed to differentiate the two based on staining for estrogen and progesterone receptors. The presence of gross cystic disease fluid protein 15 is also suggestive of metastatic breast carcinoma. The stomach has a significant capacity to distend (up to 2–4 L of food) and malignant gastric outlet obstruction is often undetected clinically until a high-grade obstruction develops. Our case demonstrates valuable teaching point in terms of broadening our differentials for gastric outlet obstruction. When patients present with gastric outlet obstruction, both non-malignant and malignant causes of gastric outlet obstruction should be considered. Once adenocarcinoma has been determined to be the cause of gastric outlet obstruction, further immunohistochemistry is needed to differentiate breast carcinoma from other carcinomas.

【 授权许可】

   
2015 Kim et al.

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【 参考文献 】

• [1]Shone DN, Nikoomanesh P, Smith-Meek MM, et al.: Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers. Am J Gastroenterol 1995, 90:1769-70.
• [2]Awan A, Johnston DE, Jamal M: Gastric outlet obstruction with benign endoscopy should be further explored for malignancy. Gastrointest Endosc 1998, 48:497-500.
• [3]Tokunaga A, Nishi K, Matsukura N, et al.: Estrogen and progesterone receptors in gastric carcinoma. Cancer 1986, 57:1376-9.
• [4]Liu H, Shi J, Wilkerson M, et al.: Immunohistochemical evaluation of GATA3 expression in tumors and normal tissues. Am J Clin Pathol 2012, 138:57-64.
• [5]Weber CA, Decker RA, Puggioni A, et al.: Previously undiagnosed infiltrating lobular carcinoma of the breast presenting as a gastric outlet obstruction. Am J Gastroenterol 2001, 12:3475-7.
• [6]Borst MJ, Ingold JA: Metastatic patterns of invasive lobular versus invasive ductal carcinoma of the breast. Surgery 1993, 114(4):637-42.
• [7]McLemore EC, Pockaj BA, Reynolds C, et al.: Breast cancer: presentation and intervention in women with gastrointestinal metastasis and carcinomatosis. Ann Surg Oncol 2005, 12(11):886-94.
• [8]Khairy S, et al. Duodenal obstruction as first presentation of metastatic breast cancer. Case Rep Surg. 2015; 2015.
• [9]Mourra N, Jouret-Mourin A, Lazure T, et al.: Metastatic tumors to the colon and rectum: a multi-institutional study. Arch Pathol Lab Med 2012, 136(11):1397-401.