Small Bowel Obstruction caused by Intestinal Metastases of Bilateral Metachronous Lobular Breast Cancer: A Case Report and Literature Review
EAES Academy. Salama M. 07/05/22; 363007; P050
Mr. Mohamed Salama
Contributions
Contributions
Abstract
Introduction
Breast cancer (BC) is a leading cause of cancer death worldwide. Metastases to the gastrointestinal tract (GIT) from breast cancer are seldom recognised in the clinical setting and its true incidence is unknown. Although breast cancer metastases to small intestine are extremely rare, it has been increasingly reported as an uncommon cause of intestinal obstruction.
Case report
A 76 year old lady with recurrent presentations for abdominal pain, nausea, vomiting and weight loss, on a background of abdominoperineal resection and chemoradiotherapy for rectal adenocarcinoma 9 years ago, and Right mastectomy, hormonal therapy and chemoradiotherapy for lobular BC 31 years ago with good surveillance. CT confirmed small bowel obstruction likely adhesive with transition point at the jejunum. Emergency laparotomy was performed and showed a stenotic mid-jejunal area which was resected with end-to-end anastomosis. Histology confirmed metastatic lobular carcinoma in keeping with previous breast cancer. Examination of left breast during this admission revealed a new, firm mass suggesting metachronous malignancy. She was referred to the breast service and biopsy confirmed lobular carcinoma.
Conclusion:
BC metastases to GIT are rare and occur more frequently in invasive lobular carcinoma. As the prognosis of BC continues to improve with modern medical practice, it is important to be aware of clinical presentations and appropriate management of BC metastases. The time interval between primary and GIT metastases may range from synchronous presentations to as long as 31 years as in this case. GI manifestation may precede BC diagnosis. The early diagnosis of bowel metastases from BC is quite challenging (very rare, non-specific clinical and radiological manifestation, long disease free interval). No consensus exists on treatment of GIT metastases from BC.
Breast cancer (BC) is a leading cause of cancer death worldwide. Metastases to the gastrointestinal tract (GIT) from breast cancer are seldom recognised in the clinical setting and its true incidence is unknown. Although breast cancer metastases to small intestine are extremely rare, it has been increasingly reported as an uncommon cause of intestinal obstruction.
Case report
A 76 year old lady with recurrent presentations for abdominal pain, nausea, vomiting and weight loss, on a background of abdominoperineal resection and chemoradiotherapy for rectal adenocarcinoma 9 years ago, and Right mastectomy, hormonal therapy and chemoradiotherapy for lobular BC 31 years ago with good surveillance. CT confirmed small bowel obstruction likely adhesive with transition point at the jejunum. Emergency laparotomy was performed and showed a stenotic mid-jejunal area which was resected with end-to-end anastomosis. Histology confirmed metastatic lobular carcinoma in keeping with previous breast cancer. Examination of left breast during this admission revealed a new, firm mass suggesting metachronous malignancy. She was referred to the breast service and biopsy confirmed lobular carcinoma.
Conclusion:
BC metastases to GIT are rare and occur more frequently in invasive lobular carcinoma. As the prognosis of BC continues to improve with modern medical practice, it is important to be aware of clinical presentations and appropriate management of BC metastases. The time interval between primary and GIT metastases may range from synchronous presentations to as long as 31 years as in this case. GI manifestation may precede BC diagnosis. The early diagnosis of bowel metastases from BC is quite challenging (very rare, non-specific clinical and radiological manifestation, long disease free interval). No consensus exists on treatment of GIT metastases from BC.
Introduction
Breast cancer (BC) is a leading cause of cancer death worldwide. Metastases to the gastrointestinal tract (GIT) from breast cancer are seldom recognised in the clinical setting and its true incidence is unknown. Although breast cancer metastases to small intestine are extremely rare, it has been increasingly reported as an uncommon cause of intestinal obstruction.
Case report
A 76 year old lady with recurrent presentations for abdominal pain, nausea, vomiting and weight loss, on a background of abdominoperineal resection and chemoradiotherapy for rectal adenocarcinoma 9 years ago, and Right mastectomy, hormonal therapy and chemoradiotherapy for lobular BC 31 years ago with good surveillance. CT confirmed small bowel obstruction likely adhesive with transition point at the jejunum. Emergency laparotomy was performed and showed a stenotic mid-jejunal area which was resected with end-to-end anastomosis. Histology confirmed metastatic lobular carcinoma in keeping with previous breast cancer. Examination of left breast during this admission revealed a new, firm mass suggesting metachronous malignancy. She was referred to the breast service and biopsy confirmed lobular carcinoma.
Conclusion:
BC metastases to GIT are rare and occur more frequently in invasive lobular carcinoma. As the prognosis of BC continues to improve with modern medical practice, it is important to be aware of clinical presentations and appropriate management of BC metastases. The time interval between primary and GIT metastases may range from synchronous presentations to as long as 31 years as in this case. GI manifestation may precede BC diagnosis. The early diagnosis of bowel metastases from BC is quite challenging (very rare, non-specific clinical and radiological manifestation, long disease free interval). No consensus exists on treatment of GIT metastases from BC.
Breast cancer (BC) is a leading cause of cancer death worldwide. Metastases to the gastrointestinal tract (GIT) from breast cancer are seldom recognised in the clinical setting and its true incidence is unknown. Although breast cancer metastases to small intestine are extremely rare, it has been increasingly reported as an uncommon cause of intestinal obstruction.
Case report
A 76 year old lady with recurrent presentations for abdominal pain, nausea, vomiting and weight loss, on a background of abdominoperineal resection and chemoradiotherapy for rectal adenocarcinoma 9 years ago, and Right mastectomy, hormonal therapy and chemoradiotherapy for lobular BC 31 years ago with good surveillance. CT confirmed small bowel obstruction likely adhesive with transition point at the jejunum. Emergency laparotomy was performed and showed a stenotic mid-jejunal area which was resected with end-to-end anastomosis. Histology confirmed metastatic lobular carcinoma in keeping with previous breast cancer. Examination of left breast during this admission revealed a new, firm mass suggesting metachronous malignancy. She was referred to the breast service and biopsy confirmed lobular carcinoma.
Conclusion:
BC metastases to GIT are rare and occur more frequently in invasive lobular carcinoma. As the prognosis of BC continues to improve with modern medical practice, it is important to be aware of clinical presentations and appropriate management of BC metastases. The time interval between primary and GIT metastases may range from synchronous presentations to as long as 31 years as in this case. GI manifestation may precede BC diagnosis. The early diagnosis of bowel metastases from BC is quite challenging (very rare, non-specific clinical and radiological manifestation, long disease free interval). No consensus exists on treatment of GIT metastases from BC.
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