Danbury Hospital - Yale School of Medicine Danbury, CT
Award: Presidential Poster Award
Mohammad A. Ahmed-Khan, MD1, Jacob Lovin, DO2, Prabasha Weeraddana, MD2, Shubhneet Bal, MD2, Mahnoor Hanif, MD3, Marina Kelada, MD4, Kelly Teagle, DO5 1Danbury Hospital - Yale School of Medicine, Danbury, CT; 2Danbury Hospital, Danbury, CT; 3CMH Lahore Medical College, Lahore, Punjab, Pakistan; 4Connecticut Institute for the Communities, Danbury, CT; 5Nuvance Health, Danbury, CT
Introduction: Breast Cancer (BC) is a very common form of cancer and is rapidly becoming one of the most common forms of cancer leading to mortality in the world especially in the case of women. It is important to think outside the box in cases of metastatic breast cancer due to its propensity for bone, brain, or liver metastasis clinicians tend to get tunnel vision working up patients with new onset symptoms of known BC. Breast cancer can also metastasize albeit rarely to the gastrointestinal tract, in this case we present a patient with metastatic breast cancer to the gastrointestinal tract mimicking diarrheal disease.
Case Description/Methods: A 57-year-old female with a past history of invasive lobular carcinoma of the right breast, and triple negative left breast cancer presented to an outpatient GI clinic with a chief complaint of worsening diarrhea and weight loss associated with crampy abdominal pain and relief on the passage of stool. The patient was initially worked up for gastrointestinal infections, inflammatory bowel disease, celiac disease prior to finally evaluating the patient endoscopically. On colonoscopy the patient was discovered to have diffuse areas of congested, erythematous, scarred, and vascular pattern decreased mucosa of which biopsies were obtained; the texture of the tissue was unusually difficult to grasp during sampling as noted by the endoscopist. Samples evaluated by pathology came back positive for metastatic carcinoma consistent with primary breast origin with positive markers: CK7, GATA3, ER and PR receptor. She was then scheduled to see oncology for further work-up and management of Stage IV Metastatic Breast Cancer.
Discussion: Breast cancer is classified into two types: ductal and lobular carcinoma. It most commonly metastasizes to the bone, lungs, liver, and brain. The gastrointestinal (GI) tract can also be affected, with an incidence of 6-18% of cases. Literature indicates that GI metastasis from breast cancer is often misdiagnosed as inflammatory bowel disease (IBD) or diarrheal disease, leading to delays in diagnosis. Therefore, clinicians need to be aware of the possibility of GI metastases presenting in this manner, as was the case with our patient. Currently, the diagnosis and management of these metastases are controversial due to limited studies on outcomes and the risk of false negatives in early disease biopsies. Further research is necessary to classify this pathology and provide improved diagnostic and therapeutic options.
Figure: A Biopsy - Pathology: The H&E stained images show dis-cohesive tumor cells with increased N:C ratio and hyperchromatic nuclei infiltrating the lamina propria causing its expansion. Some tumor cells show signet ring morphology with intracytoplasmic mucin and eccentrically placed nuclei.
B Biopsy - Staining: Tumor cells Positive for GATA-3 Top Left, CK-7 Top Right, PR Bottom Left and ER Bottom Right.
Mohammad Ahmed-Khan indicated no relevant financial relationships.
Jacob Lovin indicated no relevant financial relationships.
Prabasha Weeraddana indicated no relevant financial relationships.
Shubhneet Bal indicated no relevant financial relationships.
Mahnoor Hanif indicated no relevant financial relationships.
Marina Kelada indicated no relevant financial relationships.
Kelly Teagle indicated no relevant financial relationships.
Mohammad A. Ahmed-Khan, MD1, Jacob Lovin, DO2, Prabasha Weeraddana, MD2, Shubhneet Bal, MD2, Mahnoor Hanif, MD3, Marina Kelada, MD4, Kelly Teagle, DO5. P1701 - From Breast to Bowels : A Rare Presentation of Colonic Metastasis of Primary Breast Cancer, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.