Bilateral Invasive Lobular Cancer Presenting with Multiple GastroIntestinal and Disseminated Metastasis
Among the commonest malignancy in women is Breast Cancer (BC), Invasive Lobular Carcinoma (ILC) is the second common type of breast malignancy, after Invasive Ductal Carcinoma (IDC), accounting for about 5-16% of all breast malignancies . BC commonly metastasize to regional lymph node, bone, lung, liver and brain. Metastases from BC to the Gastrointestinal Tract (GIT) are rare and occurs in less than 1% . However, when considering ILC cases alone, GIT metastases occurs in as high as 6% . Incidence of GIT metastasis in BC patients may be rare in clinical practice but in autopsy series, the incidence of GI metastasis in BC patient varied between 8-35%.
A 43-year-old women who was otherwise healthy, presented with persistent dyspepsia and abdominal distention for 2 months. She had distended abdomen with fluid shifting on physical examination. After initial investigations with endoscopic Gastroduodenoscopy (EGD) and abdominal CT, she was found to have massive ascites, bilateral ovarian enlargement with irregular mass like lesion, bilateral hydronephrosis and peritoneal deposit giving the impression of ovarian cancer with peritoneal and periuretral metastasis, suggested due to hydronephrosis (Figure 1). Other primaries such as colon cancer were also considered. Her endoscopic findings showed a gastric lesion at the lower body (Figure 2). Biopsy was taken and sent for histopathological study and showed signet ring cell carcinoma which directed the provisional diagnosis towards gastric cancer as the primary disease. Afterwards, she underwent a diagnostic laparoscopy which showed a left pelvic wall mass which was histopathologically confirmed as metastatic invasive lobular carcinoma. Subsequently both mammogram and breast ultrasound were per-formed and displayed left breast mass, and a suspicious right upper central lesion in addition to prominent left axillary lymph nodes which correlated with her physical examination of left palpable mass .
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International Journal of Case Reports