Metastatic breast cancer from gastric and ovarian cancer,mimicking inflammatory breast cancer: report of two cases

Breast metastases from extra-mammary malignancies, especially those mimicking primary inflammatory breast carcinoma, are extremely rare. We report here two cases of inflammatory breast metastases from gastric or ovarian cancer. Both patients, who had prior advanced malignant disease, presented with unilateral breast redness and swelling with peau d’orange sign, resembling primary inflammatory breast cancer or acute mastitis. Breast biopsy revealed poorly differentiated adenocarcinoma with signet-ring cells or clear cell carcinoma in the lymphatic vessels and the parenchyma without an in situ lesion, similar to primary lesions of the stomach or ovary, respectively. Immunohistochemical staining for estrogen receptor, progesterone receptor, and gross cystic disease fluid protein 15 was of value for correct diagnosis. Since breast metastasis is a sign of poor prognosis of the primary malignant disease, the possibility of breast metastasis should be considered in appropriate patients to preclude unnecessary major surgery.     

Gastric carcinoma metastatic to the breast.

A patient with signet ring adenocarcinoma of the stomach with metastatic disease to the breast treated at our institution is presented and added to the 14 cases reported in the literature. A review of the common clinical features and possible mechanisms of metastases is given. While the majority of patients present with symptoms referable to their gastric malignancy, the patient in this case initially sought treatment because of her breast mass. Metastatic deposits within the breast may be difficult to distinguish from primary breast carcinoma. For this reason, immunohistochemistry utilizing carcinoembryonic antigen (CEA), C-ERB B-2, and gross cystic protein were used in this case to confirm an extramammary source. In order to prevent unnecessary breast surgery and provide proper treatment of the gastric primary, the patient's complete clinical presentation must be used to guide diagnostic evaluation.     

An autopsy case of gastric metastasis simulating linitis plastica carcinoma from primary linitis plastica carcinoma of the rectum

Cases of a metastatic involvement of the stomach from a colorectal cancer are extremely rare, and once such case, confirmed by autopsy, is reported. The patient, an 86-year-old woman, had a metastatic lesion of the stomach from a rectal cancer. The rectal cancer was a combined linitis plastica type and signet ring cell carcinoma, and the appearance of metastatic lesion of the stomach had simulated the linitis plastica type cancer. A metastatic involvement of the stomach presenting a linitis plastica type cancer from a breast cancer is well documented, but a linitis plastica type from a colorectal cancer has not been reported. This case is the first report concerning a gastric metastasis presenting linitis plastica type lesion from a colorectal cancer.     

A case of gastric metastases from carcinoma of the breast

Reported is a case of a gastric metastases from a cancer of the breast in a 54-year-old woman who had received a standard radical mastectomy for a cancer of the right breast (T2N1bM0). Microscopic examination had revealed a lobular carcinoma, partially showing a signet ring appearance, and metastases in 4 axillary lymph nodes. Two years and 6 months later as a result of an upper GI series and a gastroscopy, linitis plastica was observed. Because there were no other metastatic lesions, a laparotomy was performed. The stomach, however, was unresectable. Further, a nodal biopsy revealed a metastatic breast cancer. Because of the probe laparotomy, however, the patient's symptoms were aggravated for several months. Death occurred three years and five months after the mastectomy. An autopsy revealed systemic metastases which included the stomach that had originated from her breast.     

Signet ring cell carcinoma of the stomach.

Between 1965 and 1985, 51 of 1500 patients (3.4%) with gastric cancer who had gastric resection had signet ring cell gastric cancer. Patients with this form of cancer tended to be younger and female; the tumors were smaller and involved the stomach body, serosal invasion was less prominent, and lymph node metastases were less likely to be present. Early mucosal and submucosal cancer was present in 54.9% of the patients with the signet ring cell and in 24.6% with other types of gastric cancer. In 15.7% of patients with signet ring cell cancer, a noncurative resection was performed. The 5-year survival rate was 74.5% for patients with signet ring cell cancer and 52.4% for those with other types of gastric cancer (P less than 0.01). In patients with signet ring cell gastric cancer, the lesion is less extensive; thus, these patients probably can expect a longer survival time.     

Gastric tumor from metastasis of breast cancer

Metastatic tumours of the stomach have been reported to result from various types of cancer. Among them, gastric metastasis from breast cancer has been recognised in 0.3-18% patients (1-4). Here, a rare case of metastatic gastric tumour derived from breast carcinoma is reported. Gastric endoscopy confirmed a large, friable mass (approximately 5 cm in diameter) in the upper part of the gastric body. The mass within the stomach was difficult to distinguish from primary gastric cancer, although biopsies of this lesion revealed the characteristics of adenocarcinoma. In addition, immunohistochemistry showed the positive expression of mammaglobin. Taken together, the evidence pointed to metastasis of breast cancer to the stomach. The patient was treated with hormonal therapy (letrozole), and the size of the metastasis in the stomach was markedly reduced. Therefore, a gastric metastasis from breast cancer was diagnosed successfully using immunohistochemistry and unnecessary surgery was avoided. In conclusion, although gastric metastatic tumours derived from breast carcinoma are rare, their accurate pre-operative diagnosis and appropriate systemic treatment is essential.     

A case of primary signet ring cell carcinoma of the breast

A rare case of primary signet ring cell carcinoma of the breast is reported. The patient was a 54-year-old unmarried female (G 0, P 0, AB 0) with a several months' history of inflammatory reactions, such as infection, erosion, and a swelling of her entire left breast. She died of this disease in 6 months despite an operation and combined chemotherapy (CMF). Her serum CEA level had well reflected the course of her treatment. Histopathologically, a primary lesion and axillary lymph nodes were found to be filled with typical signet ring cells, whose cytoplasm showed positive staining for PAS and Alcian blue stains as well as CEA. This case, both clinically and histopathologically, displayed the peculiar characteristics of signet ring cell carcinoma, which differs from other types of breast cancer.     

Metastatic signet ring cell gastric carcinoma presenting as an infrarenal aortic aneurysm

Metastases to liver, lungs, bone, and adrenal glands are common events in advanced gastric carcinoma. Occasionally, metastases to other parts of the body, such as the prostate gland [1] the gluteal muscle [2], or the cervix [3] are described. However, these are rare events in the natural history of the disease. We report an unusual case of a signet ring cell gastric carcinoma, initially presenting as an infrarenal aortic aneurysm. Following resection of the aneurysm, the spread of lymphangiosis carcinomatosa into the aortic wall and infiltration of signet ring cells into an adjacent lymph node were noted. The primary tumor, a signet ring cell gastric carcinoma, was detected by a subsequent esophago-gastro-duodenoscopy     

A case report of synchronous small cell lung cancer and gastric cancer successfully treated with carboplatin

A 53-year-old man complained of anorexia and abdominal distention of one month's duration. The chest X-ray demonstrated a mass in the left lung with hilar and mediastinal adenopathy and a lytic lesion in the right fourth rib. A transbronchoscopic biopsy of the mass revealed oat cell carcinoma (WHO classification). The endoscopic evaluation also revealed a gastric lesion (IIc type). Biopsy of this lesion indicated signet ring cell gastric cancer. An abdominal CT scan demonstrated multiple liver metastases. Based on these findings, the patient was diagnosed as having synchronous lung and gastric primaries, with liver and bone metastasis from lung cancer. Carboplatin (CBDCA) was administered by intravenous drip infusion of 450 mg/m2. After a second treatment with CBDCA about 3 weeks later, the patient achieved a partial response at the primary site of lung cancer as well as at the liver and bone metastases. In addition, repeat endoscopy of the stomach demonstrated a complete regression. A biopsy specimen taken by gastroscopy was negative for cancer cells. Subsequent chemotherapy for small cell lung cancer was administered with cyclophosphamide, adriamycin, and vincristine, and to date there is no evidence of recurrence. Further studies on CBDCA treatment of small cell lung cancer and gastric cancer are needed to establish the efficacy of this drug against these two histologically different cancers.     

33例印戒细胞癌的临床分析

目的探讨胃印戒细胞癌的临床病理特征及预后。方法回顾性分析166例胃癌患者中印戒细胞癌与非印戒细胞癌的临床病理特征及术后生存情况的差异。结果 166例胃癌中印戒细胞癌为33例(19.9%),非印戒细胞癌133例(80.1%),两者性别、病变部位、分化程度、肿瘤浸润深度、淋巴结转移、有无远处转移及临床分期等差异均无统计学意义(P>0.05);而两者年龄分布差异显著(P=0.032),印戒细胞癌中60岁以下患者更多见;印戒细胞癌中侵犯神经的比例也明显高于非印戒细胞癌(P=0.021)。印戒细胞癌患者的4年生存率为42.4%,明显低于非印戒细胞癌患者的66.2%(P<0.05)。结论相对于非印戒细胞癌,胃印戒细胞癌的发病年龄轻,神经侵犯比例高,预后差。     

Metastatic Hepatocellular Carcinoma Mimicking an Early Gastric Cancer: A Case Report

A case of hepatocellular carcinoma metastasizing to the stomachin a 71-year-old man is reported. The gastric metastasis showeda flat elevation compatible with type IIa of early gastric canceron roentgenograms and a white saucer-like, discolored elevationon endoscopic pictures. It had none of the modalities of polypoidsubmucosal tumor usually observed in metastatic tumors of thestomach. Biopsy specimens of the lesion were not sufficientto distinguish metastatic or primary gastric cancer. The patientdied of massive bleeding from varices at the gastric cardia.Autopsy disclosed hepatocellular carcinoma diffusely extendingto the bilateral lobe of the cirrhotic liver. Sections of thegastric mass showed bile deposits in the malignant cells andthe same cell pattern as the hepatic primary tumor. These findingsconfirmed it as the metastatic involvement of the stomach byhepatocellular carcinoma. Although gastric metastases usually form polypoid submucosaltumors with or without central ulceration, it is quite unusualfor gastric involvements of hepatocellular carcinoma to formsuch a modality.     

An Unusual Case of Gastric Cancer Presenting with Breast Metastasis with Pleomorphic Microcalcifications

Breast metastasis from gastric carcinoma is rare. We present a case of right breast mass with microcalcification in which the diagnosis of poorly differentiated adenocarcinoma from the stomach was made after a biopsy. Pleomorphic microcalcification was noted in the ill-defined breast mass, which is a rare feature in breast metastasis. Since breast metastasis usually signifies advanced metastatic disease, differentiating primary breast cancer from metastasis is important for appropriate treatment.     

Early Gastric Cancer Induced by N-Ethyl-N'-nitro-N-nitrosoguanidine in a Cynomolgus Monkey Six Years after Initial Diagnosis of the Lesion

A signet ring cell carcinoma in the gastric antrum of a Cynomolgus monkey induced by N-ethyl-N′-nitro-N-nitrosoguanidine was sequentially studied by endoscopy, biopsy, and autopsy. The carcinoma was first detected on the angulus of the stomach at the 38th month as a slightly elevated lesion. Sixty-one months later this tumor was found to be still in the “early”(intramucosal) stage. Another, independent, initial gastric cancer was also discovered. This is the first example of an induced gastric carcinoma remaining in the “early’stage during a six-year follow-up period after the initial histologic diagnosis.     

Metastatic cancers of the thyroid gland. Diagnostic difficulties

Metastatic carcinoma of the thyroid is uncommon in surgical pathology and may masquerade as primary thyroid cancer. We studied 6 cases of biopsied and/or surgically resected metastatic carcinoma of the thyroid and their corresponding primary carcinoma, with emphasis on the differential diagnosis. There were 4 men and 2 women patients aged 44 to 77. The primary carcinoma was a breast infiltrating duct carcinoma (3 cases), a colorectal adenocarcinoma (2 cases) and a bronchial oat-cell carcinoma (1 case). The interval between primary carcinoma and secondary thyroid carcinoma was 2 to 9 years in 4 cases; 2 other cases showed simultaneous occurrence. Five patients died with widespread metastases 1 to 14 months following the diagnosis of secondary carcinoma of the thyroid; 1 patient was alive after 24 months. The histological differentiation of secondary from primary thyroid cancer may be difficult in the following situations: clear-cell, Hürthle-cell and signet ring cell changes; positivity of mucins stains; production of melanin; epidermoid differentiation; very rare miscellaneous tumours ("columnar cell carcinoma" and primary thymoma of the thyroid). Immunoperoxidase methods and mucin histochemistry may help.     

A Case of Esophageal Carcinoma and Collision Tumor of the Stomach

A case of double primary cancer of the esophagus and stomachwith metastasis of the esophageal cancer to the stomach is reported.The entire stomach and the lower part of the esophagus weresurgically resected and intrathoracic esophagojejunostomy wasperformed. Macroscopically, two tumors were found to be present,both in the lower esophagus and the stomach. There were twoprimary cancers, one a squamous cell carcinoma of the esophagusand the other a collision tumor of the stomach which consistedof well-differentiated adenocarcinoma and signet ring cell carcinoma.Furthermore, this collision tumor was present together witha metastatic lesion from the esophageal carcinoma.     

乳腺印戒细胞癌和粘液腺癌的临床病理分析

目的 :比较研究乳腺印戒细胞癌和粘液腺癌的临床及病理学特点的差异。方法 :对 11例乳腺印戒细胞癌和 58例乳腺粘液腺癌的临床和病理特征进行对比分析。结果 :乳腺印戒细胞癌 3年生存率 63.63% ,5年生存率 9.0 9% ,粘液腺癌 3年生存率 94 .83% ,5年生存率 81.0 3%。显微镜下二者粘液分布不同 ,肉眼所见大体标本相差甚远。结论 :乳腺印戒细胞癌较粘液腺癌恶性程度高、预后差 ,在临床上有必要从粘液腺癌中独立出来。     

Primary gastric signet ring cell carcinoma presenting as cardiac tamponade

Primary gastric signet ring cell carcinoma presenting as cardiac tamponade is difficult to diagnosis early.Patients are generally asymptomatic until the disease is advanced.General practitioners usually focus on the initial symptoms related to pericarditis and pericardial effusion.We report a case of signet-ring cell carcinoma of the stomach presenting as cardiac tamponade with pericarditis and pericardial effusion but without any gastrointestinal symptoms.A 49-year old woman was admitted because of progressive dyspnea and cough.Chest X-ray revealed an increased cardiothoracic ratio and a small amount of bilateral pleural effusion.Two dimensional ultrasonographic echocardiography pericardial effusions with atrial and right ventricular early diastolic collapse were found,establishing the diagnosis of cardiac tamponade.Pericardiocentesis was performed and 420 mL of bloody fluid was taken.The patient died of respiratory failure and cardiac arrest on October 28,2009.Post-mortem examination revealed diffuse gastric mucosa erosion and edema with stomach mucosa incrassation in the greater curvature.The primary lesion was histopathologically diagnosed as signet-ring cell carcinoma of the stomach.     

A rare case of poorly differentiated endocrine cell carcinoma of the stomach with signet ring cell differentiation

There have been few reports of the dual differentiation of different cell types within the same gastric tumor. Here, we report a rare case of poorly differentiated endocrine cell carcinoma with an associated differentiated signet ring cell population arising in the stomach. The histological appearance of the tumor by light microscopy matched the phenotype of endocrine cell carcinoma and signet ring cell differentiation with mucinous lakes. Cells with a phenotype intermediate between the two differentiated cell types were also seen in the tumor. Both the endocrine cell carcinoma and the signet ring cells were diffusely positive for chromogranin A and synaptophysin, a finding that is consistent with endocrine differentiation by immunohistochemical examination. The patient’s postoperative clinical course had a poor prognosis, with aggressive tumor progression. Paraaortic lymph node recurrence was found 6 months after the operation, and the patient died of the primary disease 16 months after the surgical treatment.     

Prognostically favorable abdominal breast cancer metastases with stomach involvement

BACKGROUND: Abdominal metastases with stomach involvement are rare in breast cancer. The median disease free interval from the time of breast cancer diagnosis to gastric metastasis is usually very long. Treatment is generally palliative, and expected survival time is less than 1 year. CASE REPORT: A 59-year-old woman with breast cancer developed diffuse abdominal metastases involving stomach, abdominal lymph nodes, and omentum 9 years after she underwent mastectomy and adjuvant chemotherapy. The histopathologic diagnosis found by stomach specimen examination was invasive lobular carcinoma, and the cells expressed high levels of estrogen and progesterone receptors. The abdominal metastases were treated with surgery, postoperative chemotherapy, and further hormonal therapy. This was successful, and the patient has been in remission for more than 3 years. CONCLUSION: Once the definitive diagnosis of breast cancer metastases to the abdomen including the stomach is established, treatment that targets systemic breast cancer must be initiated. Our patient's extended survival time suggests that surgical treatment could be considered for selected patients.     

Urinary bladder metastases from breast carcinoma: review of the literature starting from a clinical case

Bladder metastases from solid tumors are rare. Breast carcinoma cells seldom spread to the urinary bladder. We report the case of a patient with invasive breast carcinoma who developed a breast recurrence followed by bone and urinary bladder metastases. Starting from this clinical case we review the available literature on this issue. Only few cases of urinary bladder metastases from primary breast cancer have been reported, although the case reports have increased in recent years. Patients with breast cancer presenting with urinary symptoms should be examined for possible bladder metastases.