Breast cancer metastasis to the stomach

Abstract

Aim: This study focuses on the stomach as an unusual but not rare site of metastasis of breast cancer.

Methods: We performed a literature search on gastric metastasis from breast cancer searching for reviews from 2000 to 2018 and case reports from 2013 to 2018. We found 11 reviews and 36 case reports and we compared their findings about important aspects of gastric metastasis, such as disease free survival, overall survival, symptoms, endoscopic findings, therapy, histology, and immunohistochemistry.

Results: The incidence of stomach as site of metastasis of breast cancer ranges from 5% to 18%. Reviews and case reports reached similar conclusions about several of the aforementioned aspects: invasive lobular breast cancer (ILC) is mainly responsible for gastric metastases; disease free survival can vary greatly ranging from 0.5 months to 30 years; gastric metastases usually present with non-specific symptoms, even though five patients in case reports were asymptomatic; linitis plastica is the most common endoscopic finding; immunohistochemistry is essential for differentiating primary gastric cancer from metastasis; the preferred treatment is systemic therapy, but surgery is still an option in case of emergency; median overall survival of patients with gastric metastasis from breast cancer is 24 months.

Conclusion: Breast metastasis to the stomach should be considered in any patient suspecting gastric neoplasm previously treated for breast carcinoma, especially if the treated carcinoma was ILC.

Keywords

Gastric metastasis / breast cancer / immunohistochemistry / stomach

References

[1] Forouzanfar MH,Delossantos AM,Lopez AD.Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis..Lancet2011;378:1461-84

[2] Fondrinier E,Lorimier G.A comparative study of metastatic patterns of ductal and lobular carcinoma of the breast from two matched series (376 patients)..Bull Cancer1997;84:1101-7

[3] Taal BG,Steinmetz R.The spectrum of gastrointestinal metastases of breast carcinoma: I. stomach..Gastrointest Endosc1992;38:130-5

[4] Taal BG,Boot H.Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma..Cancer2000;89:2214-21

[5] Schwarz RE,Turnbull AD.Metastatic breast cancer masquerading as gastrointestinal primary..Am J Gastroenterol1998;93:111-4

[6] Cormier WJ,Welch JM,Edmonson JH.Linitis plastica caused by metastatic lobular carcinoma of the breast..Mayo Clin Proc1980;55:747-53

[7] Pectasides D,Pliarchopoulou K,Papaxoinis G.Gastric metastases originating from breast cancer: report of 8 cases and review of the literature..Anticancer Res2009;29:4759-63

[8] Ayantunde AA,Parsons SL.Esophagogastric cancers secondary to a breast primary tumor do not require resection..World J Surg2007;31:1597-601

[9] Villa Guzmán JC,Cervera R,Patón R.Gastric and colon metastasis from breast cancer: case report, review of the literature, and possible underlying mechanisms..Breast cancer: target and therapy2017;9:1-7 PMCID:PMC5207330

[10] Reiman T.Upper gastrointestinal bleeding as a metastatic manifestation of breast cancer: a case report and review of the literature..Can J Gastroenterol2001;15:67-71

[11] Critchley AC,Carr M.Synchronous gastric and colonic metastases of invasive lobular breast carcinoma: case report and review of the literature..Ann R Coll Surg Engl2011;93:e49-50 PMCID:PMC5827216

[12] Weigt J.Metastatic disease in the stomach..Gastrointest Tumors2015;2:61-4 PMCID:PMC4668793

[13] Namikawa T.Clinicopathological features and treatment outcomes of metastatic tumors in the stomach..Surg Today2014;44:1392-9

[14] Barranco R,Ventura F.A fatal gastric perforation secondary to ulcerated metastasis in undiagnosed breast cancer: pathological aspects and review of literature..Malays J Pathol2017;39:181-7

[15] Jones GE,Forshaw MJ,Mahedeva U.Breast cancer metastasis to the stomach may mimic primary gastric cancer: report of two cases and review of literature..World J Surg Oncol2007;5:75 PMCID:PMC1937002

[16] Aurello P,Cosenza G,Stoppacciaro A.Gastric metastasis 14 years after mastectomy for breast lobular carcinoma: case report and literature review..Am Surg.2006;72:456-60

[17] Ellis MC,Barnett J,Vetto JT.Gastric malignancies in breast cancer survivors: pathology and outcomes..Am J Surg2009;197:633-6

[18] Kayılıoğlu SI,Esen E,Kocaay AF.Gastric metastasis of ectopic breast cancer mimicking axillary metastasis of primary gastric cancer..Case Rep Gastrointest Med2014;2014:232165 PMCID:PMC4276682

[19] Ulmer LL,Jha LK,Fisher KW.Use of Endoscopic Ultrasound in a Diagnostic Dilemma: Metastatic Breast Cancer to the Stomach..Case Rep Gastrointest Med2018;15:2018:2820352 PMCID:PMC5925204

[20] El-Hage A,Afif W,Hogue JC.Metastatic pattern of invasive lobular carcinoma of the breast-emphasis on gastric metastases..J Surg Oncol2016;114:543-7

[21] Libânio D,Pimentel-Nunes P.Gastric metastasis of breast cancer after 20 years..GE Port J Gastroenterol2018;25:99-101 PMCID:PMC5892318

[22] Kim DH,Choi YJ.Gastric metastasis from invasive lobular breast cancer, mimicking primary gastric cancer: a case report..Medicine (Baltimore)2018;97:e0258 PMCID:PMC5895432

[23] Woo J,Lee KE,Lim W.Gastric metastasis as the first presentation one year before diagnosis of primary breast cancer..Am J Case Rep2018;26:354-9 PMCID:PMC5884313

[24] Horimoto Y,Arakawa A,Saito M.Metastatic colonic and gastric polyps from breast cancer resembling hyperplastic polyps..Surg Case Rep2018;23:23 PMCID:PMC5866257

[25] Kliiger J.Metastasis to the pancreas and stomach from a breast cancer primary: a case report..J Community Hosp Intern Med Perspect2017;19:234-7 PMCID:PMC5637649

[26] Rodrigues MV,Lopes LR,Andreollo NA.Breast cancer metastasis in the stomach: when the gastrectomy is indicated ?.Arq Bras Cir Dig2016;29:86-9(in English, Portuguese) PMCID:PMC4944741

[27] Gurzu S,Bara T,Bara T.The epithelial-mesenchymal transition pathway in two cases with gastric metastasis originating from breast carcinoma, one with a metachronous primary gastric cancer..Recent Pat Anticancer Drug Discov2018;13:118-24

[28] Arslan NÇ,Bora S.Gastric metastasis of breast cancer mimicking primary gastric cancer: a case report..Turk J Gastroenterol2012;23:808-9

[29] Buka D,Richter I,Cyrany J.Gastric and colorectal metastases of lobular breast carcinoma: a case report..Acta Medica (Hradec Kralove)2016;59:18-21

[30] Ulanja MB,Al-Mashhadani A,Al-Tekreeti M.Gastrointestinal bleed from erosive gastritis and duodenitis: a sentinel event of invasive lobular carcinoma of the breast and a diagnostic dilemma..Cureus2018;10:e2757 PMCID:PMC6080734

[31] Zhang B,Kalmaz D.Gastrointestinal manifestations of breast cancer metastasis..Dig Dis Sci2014;59:2344-6

[32] Eren OO,Sonmez O,Ozkan F.Gastric metastasis in a patient with lobular breast carcinoma 6 years after diagnosis..J Gastrointest Cancer2014;45:504-5

[33] Joshi P,Jain R,Sinhasan S.Stomach metastasis of breast carcinoma mimicking primary gastric neoplasm on fluorodeoxy glucose-positron emission tomography-computed tomography..Indian J Med Paediatr Oncol2013;34:128-9 PMCID:PMC3764734

[34] Abid A,Monga DK.Breast cancer metastasis to the GI tract may mimic primary gastric cancer..J Clin Oncol2013;31:e106-7

[35] Fernandes GS,Carvalho EP,Hoff PM.Gastric and endobronchial metastases in a case of lobular breast cancer..Case Rep Oncol2013;6:555-60 PMCID:PMC3843932

[36] Tan L,Liu Z,Song F.Breast cancer metastasis to the stomach confirmed using gastroscopy: a case report..Oncol Lett2014;8:1205-7 PMCID:PMC4114584

[37] Geredeli C,Omeroglu E,Cicekci F.Gastric metastasis of triple negative invasive lobular carcinoma..Rare Tumors2015;7:5764 PMCID:PMC4508641

[38] Dória MT,Martins SN Filho,Boufelli G.Gastric metastasis as the first manifestation of an invasive lobular carcinoma of the breast..Autops Case Rep2015;5:49-53 PMCID:PMC4636107

[39] Yagi Y,Yoshikawa A,Fukushima W.Metastatic gastric carcinoma from breast cancer mimicking primary linitis plastica: a case report..Oncol Lett2015;10:3483-7 PMCID:PMC4665745

[40] Nakamura J,Sato H,Kai K.Repeated changes of the molecular subtype in gastric metastasis from breast cancer: a case report..Mol Clin Oncol2016;4:695-8 PMCID:PMC4840482

[41] Wong CS,Kiruparan P.Gastric perforation secondary to metastasis from breast cancer..BMJ Case Rep2016;2016: PMCID:PMC4964250

[42] Dos Santos Fernandes G,de Assis Pereira I,Vieira YO.Gastric metastasis of breast cancer: a case series..Rare Tumors2016;8:6305 PMCID:PMC5064297

[43] Ricciuti B,Ravaioli N,Brambilla M.Ductal breast carcinoma metastatic to the stomach resembling primary linitis plastica in a male patient..J Breast Cancer2016;19:324-9 PMCID:PMC5053318

[44] Jmour O,Mghirbi F,Doghri R.Gastric metastasis of bilateral breast cancer..J Gastrointest Oncol2017;8:E16-20 PMCID:PMC5334049

[45] Bushan K,Singh C,Mahajan P.Infiltrating lobular breast cancer presenting as isolated gastric metastasis: a case report..Idian J Surg Oncol2018;9:318-22 PMCID:PMC6154363

[46] Khan I,Khan A,Zahid M.Breast cancer metastases to the gastrointestinal tract presenting with anemia and intra-abdominal bleed..Cureus2017;9:e1429 PMCID:PMC5587403

[47] Namikawa T,Ogawa M,Munekage M.Clinical presentation and treatment of gastric metastasis from other malignancies of solid organs..Biomed Rep2017;7:159-62 PMCID:PMC5526074

[48] Yim K,Lee J.Breast cancer metastasizing to the stomach mimicking primary gastric cancer: a case report..World J Gastroenterol2017;23:2251-7 PMCID:PMC5374138

[49] Ushida Y,Horiuchi Y,Ishiyama A.Clinicopathological features of metastatic gastric tumors originating from breast cancer: analysis of eleven cases..World J Oncol2018;9:104-9 PMCID:PMC6134988

[50] Xu L,Yan N,Gu H.Metastatic gastric cancer from breast carcinoma: a report of 78 cases..Oncol Lett2017;14:4069-77 PMCID:PMC5604170

[51] Waseda Y,Kaneko S.Gastric metastasis from breast cancer visualized by magnifying endoscopy with narrow-band imaging..Dig Endosc2015;27:708-15

[52] Dupont WD.Risk factors for breast cancer in women with proliferative bresat disease..N Engl J Med1985;312:146-51

[53] McLemore EC,Reynolds C,Hernandez JL.Breast cancer: presentation and intervention in women with gastrointestinal metastasis and carcinomatosis..Ann Surg Oncol2005;12:886-94

[54] Simchuk EJ.Direct oesphageal metastasis from a distant primary tumour is a submucosal process: a review of six cases..Dis Esophagus2001;14:247-50

[55] Caramella E,Roux P,Lecomte P.Metastases of the digestive tract: report of 77 cases and review of the literature..Eur J Radiol1983;3:331-8

[56] Varanasi RV,Krims P,Colby J.Breast carcinoma metastatic to the oesophagus: clinicopathological and management features of four cases and literature review..Am J Gastroenterol1995;90:1495-9

[57] Tohfe M,Aftimos G.Gastrointestinal metastases from breast cancer; a case report..South Med J2003;96:624-5

[58] Zabel BA,Lewén S,Penfold ME.Elucidation of CXCR7-mediated signaling events and inhibition of CXCR4-mediated tumor cell transendothelial migration by CXCR7 ligands..J Immunol2009;183:3204-11

[59] Andre F,Conforti R,Boulet T.CXCR4 expression in early breast cancer and risk of distant recurrence..Oncologist2009;14:1182-8

[60] Bartolomé RA,Miquilena-Colina ME,Soto-Montenegro ML.The chemokine receptor CXCR4 and the metalloproteinase MT1-MMP are mutually required during melanoma metastasis to lungs..Am J Pathol2009;174:602-12 PMCID:PMC2630568

[61] Kryczek I,Keller E,Zou W.Stroma-derived factor (SDF-1/CXCL12) and human tumor pathogenesis..Am J Physiol Cell Physiol2007;292:C987-95

[62] Borst MJ.Metastatic patterns of invasive lobular versus invasive ductal carcinoma of the breast..Surgery1993;114:637-41discussion 641-2

[63] Hunter KW,Alsarraj J.Mechanisms of metastasis..Breast Cancer Res2008;10:S2 PMCID:PMC2605099

[64] Wendt MK,Schiemann BJ.Down-regulation of epithelial cadherin is required to initiate metastatic outgrowth of breast cancer..Mol Biol Cell2011;22:2423-35 PMCID:PMC3135469

[65] Yu HA,Seo MJ,Cho MJ.Stomach and colon metastasis from breast cancer..Ewha Med J2014;37:98-104

[66] Koike K,Higaki M,Yamazaki F.Clinicopathological features of gastric metastasis from breast cancer in three cases..Breast Cancer2014;21:629-34

[67] Signorelli C,Nelli F.Single colon metastasis from breast cancer: a clinical case report..Tumori2005;91:424-27

[68] Taal BG,van Heerde P,Hart AA.Primary non-hodgkin lymphoma of the stomach: endoscopic pattern and prognosis in low versus high grade malignancyin relation to the MALT concept..Gut1996;39:556-61 PMCID:PMC1383269

[69] Marshall ME.Gastrointestinal metastases from carcinoma of the breast..J Ky Med Assoc1983;81:154-7

[70] Qu Q,Fei XC,Xu C.The importance of biopsy in clinically diagnosed metastatic lesions in patients with breast cancer..World J Surg Oncol2014;12:93 PMCID:PMC3986435

[71] Shimada H,Koyama M.Japanese gastric cancer association task force for research promotion: clinical utility of ¹⁸f-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature..Gastric Cancer2011;14:13-21

[72] Chu PG.Immunoistochemical characterization of signet-ring cell carcinomas of the stomach, breast and colon..Am J Clin Pathol2004;121:884-92

[73] López Deogracias M,Arias-Camisón I,Murillo Guibert J.Rectal metastasis from lobular breast carcinoma 15 years after primary diagnosis..Clin Trasl Oncol2010;12:150-3

[74] Matsui M,Kawakami S,Takahashi T.The prognosis of patients with gastric cancer possessing sex hormone receptors..Surg Today1992;22:421-5

[75] Curtit E,Mansi L,Cals L.Discordances in estrogen receptor status, progesterone receptor status, and HER-2 status between primary breast cancer adn metastastis..Oncologist2013;18:667-74 PMCID:PMC4063392

[76] Tot T.The role of cytokeratins 20 and 7 and estrogen receptor analysis in separation of metastatic lobular carcinoma of the breast and metastatic signet ring cell carcinoma of the gastrointestinal tract..APMIS2000;108:467-72

[77] Werling RW,Bacchi CE.CDX2, a highly sensitive and specific marker of adenocarcinomas of intestinal origin: an immunohistochemical survey of 476 primary and metastatic carcinomas..Am J Surg Pathol2003;27:303-10

[78] Saad RS,Khalifa MA.CDX2 as a marker for intestinal differentation: its utility and limitations..World J Gastrointest Surg2011;3:159-66 PMCID:PMC3240675

[79] Bhargava R,Dabbs DJ.Mammaglobin vs GCDFP-15: an immunohistologic validation survey for sensitivity and specificity..Am J Clin Pathol2007;127:103-13

[80] Wang Z,Sienko A,Li H.Mammaglobin, a valuable diagnostic marker for metastatic breast carcinoma..Int J Clin Exp Pathol2009;2:384-9 PMCID:PMC2615595

[81] Gown AM,Kandalaft PL.Markers of metastatic carcinoma of breast origin..Histopathology2016;68:86-95

[82] Xiang X,Qu H,Yang D.Hepatocyte nuclear factor 4 alpha promotes the invasion, metastasis and angiogenesis of neuroblastoma cells via targeting matrix metalloproteinase..Cancer Lett2015;359:187-97

[83] Jucá PCFC,Vignal GM,Lustosa SAS.HFN4A expression as a potential diagnostic tool to discriminate primary gastric cancer from breast cancer metastasis in a Brazilian cohort..Diagn Pathol2017;12:43 PMCID:PMC5460322

[84] Sato T,Hasegawa M,Okada T.Breast signet-ring cell lobular carcinoma presenting with duodenal obstruction and acute pancreatitis..Asian J Surg2007;30:220-3

[85] Ciulla A,Tomasello G,Russo L.Gastric metastases originating from occult breast lobular carcinoma: diagnostic and therapeutic problems..World J Surg Oncol2008;6:78 PMCID:PMC2525652

[86] Corso G,Trentin C,Galimberti V.CDH1 germline mutations and hereditary lobular breast cancer..Fam Cancer2016;15:215-9

[87] Gjyshi O,Seewald L,Abboud E.Therapeutic and prophylactic gastrectomy in a family with hereditary diffuse gastric cancer secondary to a CDH1 mutation: a case series..World J Surg Oncol2018;16:143 PMCID:PMC6046101

[88] Figueiredo J,Carneiro P,Fernandes MS.Clinical spectrum and pleiotropic nature of CDH1 germline mutations..J Med Genet2019;56:199-208

[89] Corso G,La Vecchia C,Pravettoni G.Hereditary lobular breast cancer with an emphasis on E-cadherin genetic defect..J Med Genet2018;55:431-41

[90] Benusiglio PR,Rouleau E,Buecher B.CDH1 germline mutations and the hereditary diffuse gastric and lobular breast cancer syndrome: a multicentre study..J Med Genet2013;50:486-9