Breast carcinoma has the potential for widespread dissemination. Spread to the lower gastrointestinal tract is infrequent, often multifocal, occurs in association with spread to other sites, and most commonly develops from lobular carcinoma. Solitary colorectal metastasis as the first and sole manifestation of spread is a rare occurrence and can be confused with primary intestinal malignancy. We present a case of metastatic papillary breast carcinoma presenting as a perforated primary colon cancer. Identity of the lesion was confirmed by direct histologic comparison of the resected tumor with prior breast specimen, cytokeratin expression, and the presence of estrogen receptors.
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References
1.
GrahamWPIII, GoldmanL. Gastro-intestinal metastases from carcinoma of the breast. Ann Surg1964;159:447–80.
2.
ClavienPA, LafferU, TorhostJ, . Gastro-intestinal metastases as first clinical manifestation of the dissemination of a breast cancer. Eur J Surg Oncol1990;16:121–6.
3.
CormierWJ, GaffeyTA, WelchJM, . Linitis plastica caused by metastatic lobular carcinoma of the breast. Mayo Clinic Proc1980;55:747–53.
4.
RabauMY, AlonRJ, WerbinN, . Colonic metastases from lobular carcinoma of the breast: report of a case. Dis Colon Rectum1988;31:401–2.
5.
HoffJ, PortelR, BecueJ, . Metastases digestives des cancers du sein. Ann Chir1983;37:281–4.
6.
MarshallME. Gastrointestinal metastases from carcinoma of the breast. J Ky Med Assoc1983;81:154–7.
7.
ChangSF, BurrellMI, BrandMH, . The protean gastrointestinal manifestations of metastatic breast carcinoma. Radiology1978;126:611–7.
8.
CaramellaE, BrunetonJN, RouxP, . Metastases of the digestive tract: report of 77 cases and review of the literature. Eur J Radiol1983;3:331–8.
9.
KleinMS, SherlockP. Gastric and colonic metastases from breast cancer. Dig Dis1972;17:881–6.
10.
TaalBG, Jager denH, SteinmetzR, . The spectrum of gastrointestinal metastases of breast carcinoma: II. The colon and rectum. Gastrointest Endosc1992;38:136–41.
11.
AschMJ, WiedelPD, HabifDV. Gastrointestinal metastases from carcinoma of the breast: autopsy study and 18 cases requiring operative intervention. Arch Surg1968;96:840–3.
12.
HarrisM, HowellAC. ChrissohouM, . A comparison of the metastatic pattern of infiltrating lobular carcinoma and infiltrating ductal carcinoma of the breast. Br J Surg1984;50:23–30.
13.
WeisbergA. Metastatic adenocarcinoma of the breast masquerading as Crohn's disease of the colon. Am J Proctol Gastroenterol Colon Rectal Surg1982;33:10–5.
14.
ReesBI, OkwongaW, JenkinsIL. Intestinal metastases from carcinoma of the breast. Clin Oncol1976;2:113–9.
15.
EyresKS, SainsburyJRC. Large bowel obstruction due to metastatic breast cancer: an unusual presentation of recurrent disease. BJCP1990;44:333–4.
16.
GifaldiAS, PetrosJG, WolfeGRZ. Metastatic breast carcinoma presenting as persistent diarrhea. J Surg Oncol1992;51: 211–5.
17.
FayemiAO, AliM, BraunEV. Metastatic carcinoma simulating linitis plastica of the colon: a case report. Am J Gastroenterol1979;71:311–4.
18.
SchwarzRE, KlimstraDS, TurnbullADM. Metastatic breast cancer masquerading as gastrointestinal primary. Am J Gastroenterol1998;93:111–4.
19.
WangNP, ZeeS, ZarboRJ, . Coordinate expression of cytokeratins 7 and 20 defines unique subsets of carcinomas. Appl Immunohistochem1995;3:99–107.
20.
FisherER, GregorioRM, FisherB. The pathology of invasive breast cancer. A syllabus derived from the findings of the National Surgical Adjuvant Breast Project (Protocol No. 4). Cancer1975;36:12–85.
21.
FisherER, PalekarAS, RedmondC, . Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol No. 4): invasive papillary cancer. Am J Clin Pathol1980;73: 313–22.
