Unusual Metastatic Pathways of Breast Cancer: Authoritative Insights from Montefiore Medical Center

Good morning, good afternoon, and good evening! Today, let us take 3 minutes to share an important article published by the Department of Surgery at Montefiore Medical Center in Cureus. This article focuses on a unique case of breast cancer metastasizing to the intestines, highlighting why we should remain highly vigilant about such occurrences.

Breast cancer is one of the most common malignancies worldwide, with its primary cause of death being distant metastasis, commonly to the bones, lungs, liver, and brain. It is rare for breast cancer to metastasize to the intestines. Italian oncologist Bolzacchini and colleagues reported 96 cases of intestinal metastasis over 45 years. In reported cases, intestinal metastasis often occurs in patients with existing metastasis to other organs or systemic cancer. However, in today's case, the intestines were the initial site of metastasis, increasing the diagnostic difficulty.

Case Report

The patient was diagnosed with left-sided invasive lobular breast cancer (T3N1M0) in 2021. Estrogen receptor (ER), progesterone receptor (PR), and Her2/neu were all positive. She received a series of treatments, including mastectomy, radiotherapy, and adjuvant chemotherapy. During follow-up, no signs of recurrence were detected. However, two years later, she developed symptoms of constipation and vomiting. Physical examination revealed a full, soft abdomen with a nodule above the umbilicus, and her vital signs were stable. A barium meal and barium transit study showed areas of intestinal narrowing in the duodenum, jejunum, ileum, and ileocecal region, with pre-stenotic dilation. She was treated non-surgically for suspected radiation enteritis, but symptoms persisted.

Exploratory laparotomy revealed multiple scattered intraluminal tumors in the jejunum, ileum, cecum, transverse colon, and splenic flexure, as well as peritoneal nodules on the mesentery of both the small and large intestines. She underwent jejunoileal resection with end-to-end jejunoileal anastomosis and side-to-side ileosigmoid anastomosis.

Histological examination of the jejunoileal segment showed invasive malignant lesions with tumor cells arranged in sheets, nests, and trabeculae, consistent with metastatic adenocarcinoma, most likely originating from the primary breast tumor.

This case challenges our conventional understanding and reminds us to remain alert to atypical symptoms in daily clinical practice. Most studies indicate that lobular carcinoma is the most common breast cancer type associated with intestinal metastasis. Research by Borst et al. shows that lobular carcinoma metastasizes to the gastrointestinal tract at a rate of 4.5%, while ductal carcinoma does so at only 0.2%. Moreover, multiple synchronous primary intestinal tumors involving both the small and large intestines are rare, making the diagnosis of metastatic disease more reasonable in patients with a history of breast cancer. However, intestinal metastasis from primary breast cancer can present as isolated masses.

Clinical presentations vary widely. Some patients may experience bowel obstruction, bleeding, perforation, or symptoms mimicking other gastrointestinal diseases such as radiation enteritis and inflammatory bowel disease. Radiographic findings are usually non-specific, and many patients are diagnosed during surgery, where palliative surgical intervention may be performed with limited or no benefit.

Summary

Breast cancer metastasis to the intestines is rare, and even rarer as the first evidence of distant metastasis. This condition can easily lead to diagnostic challenges and misdiagnosis. Additionally, survival rates for intestinal metastasis are low, with few patients surviving more than 24 months after being diagnosed with gastrointestinal metastasis. Therefore, physicians should be alert to the possibility of intestinal metastasis in patients with a history of breast cancer (especially lobular carcinoma) who present with gastrointestinal symptoms, despite its rarity. Such vigilance may improve clinical outcomes.

We hope this article enhances your understanding of breast cancer. Experts at Montefiore Medical Center are dedicated to providing cutting-edge medical services and the latest research findings to help patients receive the best support and treatment in their fight against cancer.

Thank you for reading today. Aurora Health Intelligence will continue to collaborate with leading institutions like Montefiore Medical Center to advance healthcare. Follow our WeChat public account for more health information and research updates!

Article Source: DOI:10.7759/cureus.53896