Metastatic breast cancer mimicking primary depressed gastric cancer

 CommentaryBreast cancer is the most frequent malignancy to metastasize to the GI tract in women, second only to malignant melanoma. The incidence of breast cancer metastasis to the stomach has been estimated at 2% to 18% and may occur many years after the diagnosis of the primary breast lesion. In more than 90% of patients, and as in this case, there will be concurrent metastases, such as liver, lung, and bone. The upper GI tract is more frequently involved than the lower tract, and lobular infiltrating carcinoma has a greater likelihood of metastases than the ductal type. A high index of suspicion for metastatic breast cancer should be maintained whenever a patient with a history of breast cancer develops new GI symptoms or an apparent primary gastric cancer is diagnosed. The most common pattern of breast cancer metastasis to the stomach is that of linitis plastica; less commonly, discrete nodules or external compression may occur. Indeed, the clinical presentation of a breast cancer metastasis to the stomach is often indistinguishable from that of primary gastric cancer. Endoscopic, radiologic, and histologic evaluation is essential to distinguish primary gastric cancer and breast cancer metastasis to the stomach. Macroscopic endoscopic findings are usually not helpful in identifying the nature of the lesion, and because metastatic gastric infiltration frequently is confined to the submucosa and deeper layers, endoscopic evaluation may be normal or reveal only discrete mucosal abnormalities that are indistinguishable from other tumors or benign disease. Deep and extensive biopsies should be performed at endoscopy, and, as this case shows, complete histopathologic and immunohistochemical analysis of the gastric biopsies and comparison with the original breast cancer pathology is important. My compliments to these authors for perceiving such a minuscule lesion and pursuing it, despite its small size.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(09)02205-6

doi:10.1016/j.gie.2009.07.013

© 2009 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.