| Abstract: | Abstract: The endoscopic appearance of gastrointestinal metastasis from breast cancer is demonstrated in this report. A patient with breast cancer was found by panendoscope examination to have duodenal metastases. The endoscopic characteristic was that of multiple umbilicated submucosal tumors in the bulb and second portion of the duodenum. The imprint cytology of duodenal biopsy specimens, which revealed malignant cells identical to those found in the breast lump aspiration previously, supported the initial endoscopic diagnosis of metastatic breast cancer. The histology of these lesions subsequently revealed many tumor emboli in the mucosal and submucosal lymphatic channels. A laparotomy conducted to perform an intestinal bypass disclosed a large fixed metastatic tumor in the upper retroperitoneum with extension to the mesentery, the mesocolon of the transverse colon and the third portion of the duodenum. The findings at laparotomy and the histologic evidence of tumor emboli in the lymphatics of the mucosal and submucosal layers indicated a retrograde lymphatic spread of the tumor from the large retroperitoneal mass to the duodenal wall. A literature review in this report discusses the differential diagnosis from metastatic disease to second primary malignancy and benign disease of the gastrointestinal system. |
