J Gastric Cancer.  2020 Mar;20(1):106-114. 10.5230/jgc.2020.20.e1.

Bilateral Breast Metastases from Epstein-Barr Virus-Associated Gastric Cancer during Pregnancy: Is There a Method to Its Madness?

Affiliations
  • 1Medical Oncology Unit, IRCCS ICS Maugeri SpA SB, Pavia, Italy.
  • 2Department of Internal Medicine and Therapeutics, University of Pavia, PhD in Experimental Medicine, Pavia, Italy.
  • 3Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy. alessandro.vanoli@unipv.it
  • 4Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
  • 5Translational Oncology Unit, IRCCS ICS Maugeri SpA SB, Pavia, Italy.
  • 6Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of General Surgery 2, University of Pavia and IRCCS San Matteo Hospital Foundation, Pavia, Italy.

Abstract

Breast metastases of extramammary malignant neoplasms are rare, with an incidence of 0.3%-2.7% among all malignant mammary tumors. Breast metastases from gastric carcinoma are very rare (<0.1%), and this event is even rarer during pregnancy. Herein, we describe a 39-year-old Caucasian woman with a history of an Epstein-Barr virus-associated gastric carcinoma (EBVaGC) that was characterized by prominent tumor infiltrating lymphocytes. Three years after undergoing radical surgery, the patient developed bilateral breast nodules during her pregnancy. A breast biopsy was performed, and histology confirmed a diagnosis of EBVaGC; tumor cells showed positivity for cytokeratin 8/18 and E-cadherin, and negativity for cytokeratin 7, cytokeratin 20, cytokeratin 5/6, caudal type homebox 2, androgen receptor, mammaglobin, gross cystic disease fluid protein-15, and estrogen and progesterone receptors. We also discuss the main diagnostic pitfalls. To our knowledge, this is the first report of an EBVaGC with lymphoid stroma that developed breast metastases during pregnancy.

Keyword

Tumor-infiltrating lymphocytes; Pregnancy; Neoplasm metastasis; Gastric cancer; Epstein-Barr virus

MeSH Terms

Adult
Biopsy
Breast*
Cadherins
Diagnosis
Estrogens
Female
Herpesvirus 4, Human
Humans
Incidence
Keratin-20
Keratin-7
Keratins
Lymphocytes, Tumor-Infiltrating
Methods*
Neoplasm Metastasis*
Pregnancy*
Receptors, Androgen
Receptors, Progesterone
Stomach Neoplasms*
Cadherins
Estrogens
Keratin-20
Keratin-7
Keratins
Receptors, Androgen
Receptors, Progesterone
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