J Breast Cancer.  2011 Sep;14(3):247-250.

Invasive Lobular Breast Cancer Presenting an Unusual Metastatic Pattern in the Form of Peritoneal and Rectal Metastases: A Case Report

• Saranovic
• Kovac JD
• Knezevic S
• Susnjar S
• Stefanovic AD
• Saranovic
• Artiko V
• Obradovic
• Masulovic
• Micev M
• Pesko P

Abstract

Gastrointestinal metastases from invasive lobular breast cancer are uncommon with the stomach and small intestines being the most common metastatic sites. Peritoneal and rectal metastases are very rare and only rarely occur as the first manifestation of disease. We herein report the case of a 47-year-old woman who presented with abdominal carcinomatosis as a first sign of invasive lobular breast carcinoma (ILC). Identifying the most important immunohistochemical markers for ILC: gross cystic disease fluid protein 15, estrogen and progesterone receptors enabled a correct diagnosis. After a six year disease-free period, relapse occurred with severe obstruction due to rectal metastasis from lobular breast carcinoma. Since there was no widespread metastatic disease, surgery with concomitant hormonal therapy was performed.

Keyword

Breast; Lobular carcinoma; Neoplasm metastasis; Peritoneum; Rectum

MeSH Terms

Breast
Breast Neoplasms
Carcinoma
Carcinoma, Lobular
Estrogens
Female
Humans
Intestine, Small
Middle Aged
Neoplasm Metastasis
Peritoneum
Receptors, Progesterone
Rectum
Recurrence
Stomach
Estrogens
Receptors, Progesterone

Figure

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  Figure 1 Histological features of peritoneal metastasis (A) and breast biopsy: invasive lobular breast carcinoma (B) (H&E stain, ×100).

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  Figure 2 Turbo-spin-echo fat suppression T1 weighted (A) and turbo-spin-echo T2 weighted axial (B) and sagittal (C) MR image show a stage T3 rectal tumor. The tumor has intermediate signal intensity between the high signal intensity of the fat tissue and the low signal intensity of the muscular layer. Tumor signal intensity extends through the muscle layer into the perirectal fat, with obliteration of the interface between muscle and perirectal fat.

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  Figure 3 18F-FDG-PET/CT findings. (A) Axial computerized tomography (CT) image shows circumferential rectal wall thickening. (B) Axial CT attenuation-colorectal positron-emission tomography (PET) image and axial fused PET/CT image (C) revealed area of increased fluorine18-fluoro-deoxy-glucose (18F-FDG) uptake in rectal wall (standardized uptake value, SUVmax=9.8). (D) Increased uptake of 18F-FDG is also seen on maximum intensity projection reconstruction of CT attenuation-corrected PET image.

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  Figure 4 Histological and immunohistochemical features of rectal biopsy. (A) Diffuse carcinomatous infiltration of the rectal wall, mostly in the basal layer of mucosa and superficial submucosa. (B) Immunohistochemistry depicted strong immunoreactivity to gross cystic disease fluid protein 15 antigen (Immunohistochemical stain, ×100).

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  Figure 5 Clinical course of metastatic invasive lobular breast carcinoma. Signs and symptoms (☆) of the disease at the time of presentation and six years later. At first the patient underwent hysterectomy and salpingo-oophorectomy because of suspected ovarian cancer with peritoneal dissemination. After the diagnosis of metastatic invasive lobular breast cancer was made the patient received chemotherapy (FAC protocol) and tamoxifen remaining disease free for six years. The recurrence of disease was treated surgically with concomitant hormone therapy.

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