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Breast Cancer Metastasis to the Stomach That Was Diagnosed after Endoscopic Submucosal Dissection

View Article: PubMed Central - PubMed

ABSTRACT

A 52-year-old woman presented with stage IIB primary breast cancer (cT2N1M0), which was treated using neoadjuvant chemotherapy (epirubicin, cyclophosphamide, and paclitaxel). However, the tumor persisted in patchy areas; therefore, we performed modified radical mastectomy and axillary lymph node dissection. Routine endoscopy at 8 months revealed a depressed lesion on the gastric angle's greater curvature, and histology revealed signet ring cell proliferation. We performed endoscopic submucosal dissection for gastric cancer, although immunohistochemistry revealed that the tumor was positive for estrogen receptor, mammaglobin, and gross cystic disease fluid protein-15 (E-cadherin-negative). Therefore, we revised the diagnosis to gastric metastasis from the breast cancer.

No MeSH data available.


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Histopathology of the tumor, which was localized within the mucosal layer to the submucosal layer.
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fig3: Histopathology of the tumor, which was localized within the mucosal layer to the submucosal layer.

Mentions: At 8 months after the surgery, the patient underwent esophagogastroduodenoscopy for a general health check-up. The endoscopic examination revealed a slightly depressed lesion with a size of 4 mm on the greater curvature of the gastric angle (Figures 2(a) and 2(b)). Histological evaluation of a biopsy specimen revealed proliferation of signet ring cells in the proper mucosal layer of the stomach (Figure 2(c)). Destruction of the fundic glands by the cancer cells was also observed, although atypical cells were absent from the epithelium. Therefore, based on a diagnosis of primary gastric cancer, endoscopic submucosal dissection was performed. Histopathological examination of the resected specimen revealed that the tumor cells were confined to the mucosal and submucosal layers (Figures 3(a) and 3(b)). Immunostaining revealed that the tumor cells were positive for ER (Figure 3(c)), mammaglobin (Figure 3(d)), and gross cystic disease fluid protein-15 (GCDFP-15) (Figure 3(e)) and were negative for E-cadherin. Therefore, the diagnosis was revised to gastric metastasis from the primary breast cancer. The type of the primary breast cancer was also revised to invasive lobular carcinoma (rather than scirrhous carcinoma), based on the morphological and immunophenotypic characteristics of the gastric cancer cells. Although the primary breast cancer was initially misdiagnosed as scirrhous carcinoma because the tumor cells were associated with a dense connective tissue in the stroma, replacement of tumor cells with connective tissue was likely caused by the neoadjuvant chemotherapy.


Breast Cancer Metastasis to the Stomach That Was Diagnosed after Endoscopic Submucosal Dissection
Histopathology of the tumor, which was localized within the mucosal layer to the submucosal layer.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120190&req=5

fig3: Histopathology of the tumor, which was localized within the mucosal layer to the submucosal layer.
Mentions: At 8 months after the surgery, the patient underwent esophagogastroduodenoscopy for a general health check-up. The endoscopic examination revealed a slightly depressed lesion with a size of 4 mm on the greater curvature of the gastric angle (Figures 2(a) and 2(b)). Histological evaluation of a biopsy specimen revealed proliferation of signet ring cells in the proper mucosal layer of the stomach (Figure 2(c)). Destruction of the fundic glands by the cancer cells was also observed, although atypical cells were absent from the epithelium. Therefore, based on a diagnosis of primary gastric cancer, endoscopic submucosal dissection was performed. Histopathological examination of the resected specimen revealed that the tumor cells were confined to the mucosal and submucosal layers (Figures 3(a) and 3(b)). Immunostaining revealed that the tumor cells were positive for ER (Figure 3(c)), mammaglobin (Figure 3(d)), and gross cystic disease fluid protein-15 (GCDFP-15) (Figure 3(e)) and were negative for E-cadherin. Therefore, the diagnosis was revised to gastric metastasis from the primary breast cancer. The type of the primary breast cancer was also revised to invasive lobular carcinoma (rather than scirrhous carcinoma), based on the morphological and immunophenotypic characteristics of the gastric cancer cells. Although the primary breast cancer was initially misdiagnosed as scirrhous carcinoma because the tumor cells were associated with a dense connective tissue in the stroma, replacement of tumor cells with connective tissue was likely caused by the neoadjuvant chemotherapy.

View Article: PubMed Central - PubMed

ABSTRACT

A 52-year-old woman presented with stage IIB primary breast cancer (cT2N1M0), which was treated using neoadjuvant chemotherapy (epirubicin, cyclophosphamide, and paclitaxel). However, the tumor persisted in patchy areas; therefore, we performed modified radical mastectomy and axillary lymph node dissection. Routine endoscopy at 8 months revealed a depressed lesion on the gastric angle's greater curvature, and histology revealed signet ring cell proliferation. We performed endoscopic submucosal dissection for gastric cancer, although immunohistochemistry revealed that the tumor was positive for estrogen receptor, mammaglobin, and gross cystic disease fluid protein-15 (E-cadherin-negative). Therefore, we revised the diagnosis to gastric metastasis from the breast cancer.

No MeSH data available.


Related in: MedlinePlus