J Korean Soc Radiol.  2012 Feb;66(2):177-181. 10.3348/jksr.2012.66.2.177.

Occult Invasive Lobular Carcinoma of Breast Detected by Stomach Metastasis: A Case Report

• Kim SJ
• Jung HK
• Ko KH
• Yoon JH

• KMID: 1439411
• DOI: http://doi.org/10.3348/jksr.2012.66.2.177

Abstract

Gastric metastasis from primary breast cancer is a rare phenomenon that is more prevalent in the invasive lobular type of breast cancer. We describe a very rare case of occult invasive lobular cancer of the breast detected by the initial presentation of gastric metastasis in a patient without a history of breast cancer. A 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) which showed increased FDG uptake in the stomach, abdominal mesentery and the right breast, and played pivotal roles in the detection of occult primary breast cancer and a diagnosis of gastric metastasis as an ancillary method for obtaining histological results and immunohistochemical stains.

MeSH Terms

Breast
Breast Neoplasms
Carcinoma, Lobular
Coloring Agents
Humans
Mesentery
Neoplasm Metastasis
Positron-Emission Tomography
Stomach
Coloring Agents

Figure

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  Fig. 1 Contrast-enhanced abdomen CT shows diffuse gastric wall thickening, from the esophago-gastric junction to the distal antrum (arrows), as well as a large amount of ascites.

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  Fig. 2 A 57-year-old woman underwent FDG PET/CT to find a primary malignancy. A, B. Coronal images of the FDG-PET scan represent increased FDG uptake in the right breast (black arrow), stomach (white arrows), abdominal mesentery, and thoracic vertebral body (arrowheads). C. Axial images of PET-CT fusion show highlighted pathological FDG uptakes in the stomach (white arrows) and the abdominal mesenetery (arrowheads). Note.-FDG PET = 18F-fluorodeoxyglucose positron-emission tomography

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  Fig. 3 Breast sonography shows irregular spiculated and hypoechoic nodules with maximum diameters measuring approximately 24 mm with a surrounding hyperechoic rim in the right upper outer breast.

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  Fig. 4 A 57-year-old woman underwent sonography-guided breast core biopsy for the right breast nodule. A. Microscopic findings of breast core specimens reveal invasive lobular cancer cells with well-circumscribed signet ring cells as well as cytoplasmic vaculoes and eccentric nuclei (arrows) (H&E, × 100). B. Immunohistochemical staining of breast core specimens shows a positive estrogen receptor result (× 100).

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  Fig. 5 Endoscopic biopsy was performed for a huge depressed-ulcerative lesion at the lower body of the stomach in a 57-year-old woman. A. Microscopic observation of the endoscopic biopsy finds diffuse tumor infiltration (arrows) with signet cells (arrowheads) similar to the primary breast cancer in the gastric stroma with intact mucosa (H&E, × 100). B. Immunohistochemical staining of endoscopic stomach biopsy specimens represents in a positive estrogen receptor result (× 100).

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