Sawina Bhandari, MD, Sara Iqbal, MD, Pegah Hosseini-Carroll, MD
University of Mississippi Medical Center, Jackson, MS
Introduction: Breast cancer metastasis is seen in nearly 30% of cases. It most commonly spreads to the liver, brain, bones and lungs1,2. Gastrointestinal tract (GI) especially large bowel involvement is rare3,4. Usually diagnosed because of obstructive symptoms or bleeding. Endoscopic evaluation usually demonstrates obvious ulcerations, masses or stenosis. Finding a normal looking colon infiltrated by metastatic breast cancer cells is unique with incidence unknown5.
Case Description/Methods: We report a case of a 69-year-old African American female with Stage 4 Invasive lobular left breast carcinoma with metastasis to bone and chronic disseminated intravascular coagulation who was admitted for GI bleeding. She underwent upper and lower endoscopies which were unrevealing for the cause of bleeding. Her upper scope revealed erythema in the stomach and duodenal villous blunting both of which were biopsied. Colonic mucosa looked congested and ulcerations were found in the terminal ileum which were also biopsied. These findings are not per literature review typical of metastatic breast cancer. To our surprise biopsies revealed metastatic lobular breast cancer infiltration in all samples collected from stomach, duodenum, terminal ileum and colon.
Discussion: Lobular breast carcinoma more commonly metastasizes to the gastrointestinal tract6 as compared to infiltrating ductal breast cancer. In instances that it does metastasize to the colon it shows obvious endoscopic findings which was not the case in our patient. Hence we purpose that vigilant sampling of tissue be performed in patients inflicted with this disease even with subtle findings on endoscopy.
Citation: Sawina Bhandari, MD, Sara Iqbal, MD, Pegah Hosseini-Carroll, MD. P1150 - APPEARANCES ARE GLIMPSE OF THE UNSEEN. Program No. P1150. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.