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Metastatic nonpalpable invasive lobular breast carcinoma presenting as rectal stenosis: a case report.

Osaku T, Ogata H, Magoshi S, Kubota Y, Saito F, Kanazawa S, Kaneko H - J Med Case Rep (2015)

Bottom Line: A 69-year-old Japanese woman presented to our hospital for treatment of constipation.Although rectal stenosis was confirmed, thorough testing of her lower digestive tract did not identify its cause.However, breast cancer metastasis should be considered when carcinomatous peritonitis is present in a patient with an unknown primary cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Breast and Endocrine Surgery (Omori), Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8451, Japan. tadatoshi.osaku@med.toho-u.ac.jp.

ABSTRACT

Introduction: Invasive lobular carcinomas have an increased propensity for distant metastases, particularly to the peritoneum, ovaries, and uterus. In contrast, distant metastases of nonpalpable lobular carcinomas are extremely rare, and the causes of underlying symptoms of primary carcinomas remain unclear. We report a case of an asymptomatic invasive lobular carcinoma with a primary mammary lesion in a patient with rectal stenosis.

Case presentation: A 69-year-old Japanese woman presented to our hospital for treatment of constipation. Although rectal stenosis was confirmed, thorough testing of her lower digestive tract did not identify its cause. Thus, an exploratory laparotomy and tissue biopsy was performed, and the presence of an invasive lobular carcinoma was confirmed. Subsequent breast examinations showed that the invasive lobular carcinoma that led to the rectal stenosis was a metastatic lesion from a primary lesion of the breast duct. As the present breast lobular carcinoma was asymptomatic and nonpalpable, we did not initially consider metastatic breast cancer as a cause of her symptoms, and the final diagnosis was delayed.

Conclusions: Peritoneal metastasis from nonpalpable invasive lobular carcinomas is very rare. However, breast cancer metastasis should be considered when carcinomatous peritonitis is present in a patient with an unknown primary cancer.

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Related in: MedlinePlus

Histopathological findings of a peritoneal sample. The Indian file pattern of small cells (hematoxylin and eosin, ×400 magnification) suggests peritoneal metastasis from an invasive lobular carcinoma of the breast.
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Fig3: Histopathological findings of a peritoneal sample. The Indian file pattern of small cells (hematoxylin and eosin, ×400 magnification) suggests peritoneal metastasis from an invasive lobular carcinoma of the breast.

Mentions: Her surgical examinations revealed nodules dispersed throughout her abdominal cavity, and additional stenosis in her rectum and ileocecum, suggesting peritoneal metastasis. Histopathological findings from a biopsy specimen of the peritoneal material from around the rectosigmoid region were consistent with a diagnosis of peritoneal metastasis of an invasive lobular carcinoma, likely from the breast (Figure 3). However, subsequent breast examinations by the breast oncology department revealed no visible or palpable abnormalities or secretions in either of her breasts.Figure 3


Metastatic nonpalpable invasive lobular breast carcinoma presenting as rectal stenosis: a case report.

Osaku T, Ogata H, Magoshi S, Kubota Y, Saito F, Kanazawa S, Kaneko H - J Med Case Rep (2015)

Histopathological findings of a peritoneal sample. The Indian file pattern of small cells (hematoxylin and eosin, ×400 magnification) suggests peritoneal metastasis from an invasive lobular carcinoma of the breast.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4414004&req=5

Fig3: Histopathological findings of a peritoneal sample. The Indian file pattern of small cells (hematoxylin and eosin, ×400 magnification) suggests peritoneal metastasis from an invasive lobular carcinoma of the breast.
Mentions: Her surgical examinations revealed nodules dispersed throughout her abdominal cavity, and additional stenosis in her rectum and ileocecum, suggesting peritoneal metastasis. Histopathological findings from a biopsy specimen of the peritoneal material from around the rectosigmoid region were consistent with a diagnosis of peritoneal metastasis of an invasive lobular carcinoma, likely from the breast (Figure 3). However, subsequent breast examinations by the breast oncology department revealed no visible or palpable abnormalities or secretions in either of her breasts.Figure 3

Bottom Line: A 69-year-old Japanese woman presented to our hospital for treatment of constipation.Although rectal stenosis was confirmed, thorough testing of her lower digestive tract did not identify its cause.However, breast cancer metastasis should be considered when carcinomatous peritonitis is present in a patient with an unknown primary cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Breast and Endocrine Surgery (Omori), Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8451, Japan. tadatoshi.osaku@med.toho-u.ac.jp.

ABSTRACT

Introduction: Invasive lobular carcinomas have an increased propensity for distant metastases, particularly to the peritoneum, ovaries, and uterus. In contrast, distant metastases of nonpalpable lobular carcinomas are extremely rare, and the causes of underlying symptoms of primary carcinomas remain unclear. We report a case of an asymptomatic invasive lobular carcinoma with a primary mammary lesion in a patient with rectal stenosis.

Case presentation: A 69-year-old Japanese woman presented to our hospital for treatment of constipation. Although rectal stenosis was confirmed, thorough testing of her lower digestive tract did not identify its cause. Thus, an exploratory laparotomy and tissue biopsy was performed, and the presence of an invasive lobular carcinoma was confirmed. Subsequent breast examinations showed that the invasive lobular carcinoma that led to the rectal stenosis was a metastatic lesion from a primary lesion of the breast duct. As the present breast lobular carcinoma was asymptomatic and nonpalpable, we did not initially consider metastatic breast cancer as a cause of her symptoms, and the final diagnosis was delayed.

Conclusions: Peritoneal metastasis from nonpalpable invasive lobular carcinomas is very rare. However, breast cancer metastasis should be considered when carcinomatous peritonitis is present in a patient with an unknown primary cancer.

Show MeSH
Related in: MedlinePlus