1. GASTRIC METASTASIS FROM BREAST CANCER: CASE REPORT Dott. Francesco Pontieri (*) UO di Anatomia Patologica P.O. di Rossano (CS) Dott. Gianluca Dima UO di Oncologia Medica P.O. di Paola (CS) (*) Relatore Facebook

2. Gastrointestinal metastases arising from breast cancer are rarely found, with an estimated incidence rate of approximately 0.5%; in 60% of cases, they occur in stomach.

3. They mainly originate from lobular rather than ductal breast carcinoma. The reason is unknown, but some authors think that it could be related to a particular tropism of lobular cells.

4. These metastases are mostly detected within a linitis plastica image (diffuse intramural infiltration by the tumor), during endoscopic evaluations, while are extremely rare in the early gastric cancer (EGC) setting.

5. This case report deals with a gastric metastasis from ductal breast cancer in a 62 year-old woman, who had previously undergone a left radical mastectomy for a moderately differentiated grade breast carcinoma and adjuvant chemotherapy.

6. An endoscopic biopsy of gastric neoplasm was performed 14 years later, as she reported epigastralgia associated with nausea.

7. A histologic evaluation highlighted glandular elements with a predominant tubular growth pattern infiltrating the lamina propria stroma.

10. The immunohistochemical evaluation of which was ER-CK7 positive, and PR-CK20-CDX2 negative, confirming the gastric metastasis from breast carcinoma. Negative for neuroendocrine tumor: S-100, Chromogranin A, and Synaptophisin.

14. Therapeutic Decision The patients was undergone six courses of docetaxel-based chemotherapy, reporting a radiologic complete response. Actually, she is taking hormonal therapy with an aromatase inhibitor.

15. Conclusion: gastrointestinal metastases from breast carcinoma are rare; in the presence of a carcinomatous gastric neoplasm in a patient with a clinical history of invasive breast cancer, we should suppose the probability of a secondary gastric localization. the histomorphological and immunohistochemical evaluations are essential to make a correct diagnosis and a consequent adequate therapeutic protocol.

16. References : 1)B.G. Taal, H. Peterse, and H. Boot, “Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma”, Cancer, vol. 89, N. 11, pp 2214-2221, 2000, 2)P.G. Chu and L.M. Weiss, “Immunohistochemical characterization of sing-ring cell carcinomas of the stomach, breast and colon”, AJCP, vol. 121, N. 6, pp 884-892, 2004; 3)Wan Kyu Eo, “Breast ancer metastasis to the stomach resembling early gastric cancer”, Cancer Res Treat. 2008; 40(4): 207-210; 4)Titi M.A., Anabtawi A., and Newland A.D., “Isolated gastrointestinal metastasis of the breast carcinoma: a case report”; HPC, case reports in medicine, Vol. 2010, Ar. ID 615923; 5)Ambroggi M. and ot., “Metastatic breast cancer to the G.I. tract: report of five cases and review of the literature”; HPC, IJ of Breast Cancer, Vol. 2012, ID 439023.