Digestive Endoscopy 2015; 27: 708–715
Letters, Techniques and Images
713
Gastric metastasis from breast cancer visualized by magnifying endoscopy with narrow-band imaging
Figure 1 (a,b) White light endoscopy shows multiple minute discolored depressions surrounded by slightly reddish mucosa in the stomach. (c,d) Magnifying endoscopy with narrow-band imaging reveals increased tortuous dilated microvessels in the surrounding mucosa. Within the discolored depression, however, microvessels are fine and sparse, and microsurface structure is absent.
Figure 2 (a) Histopathology of endoscopic mucosal biopsy specimens taken from the lesions show a poorly differentiated adenocarcinoma with signet-ring cell morphology (hematoxylin and eosin, ×200). (b–e) Immunohistochemical analysis reveals that the lesions are positive for estrogen receptor (b, ×100), progesterone receptor (c, ×100), and mammaglobin (d, ×100), but negative for E-cadherin (e, ×100).
the gastric metastasis sometimes resembles early gastric cancer.3 Because lobular carcinoma may produce a signet-ring cell morphology,4 gastric metastasis of lobular carcinoma is often difficult to differentiate from primary gastric signet-ring cell carcinoma.3–5 To our knowledge, this is the first report of gastric metastases of lobular breast carcinoma visualized by ME-NBI. The ME-NBI findings were different from those of gastric cancer. Thus, ME-NBI may be useful for the differential diagnosis of gastric metastases of lobular breast carcinoma. Authors declare no conflict of interests for this article. Yohei Waseda, Tomoyuki Hayashi and Shuichi Kaneko Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan doi: 10.1111/den.12499
REFERENCES 1 Taal BG, Peterse H, Boot H. Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma. Cancer 2000; 89: 2214–21. 2 Almubarak MM, Laé M, Caucheux W et al. Gastric metastasis of breast cancer: a single centre retrospective study. Dig. Liver Dis. 2011; 43: 823–7. 3 Kudo T, Matsumoto T, Nakamura S et al. Solitary minute metastasis from breast cancer mimicking primary intramucosal gastric signet-cell cancer. Gastrointest. Endosc. 2005; 62: 139–40. 4 Raju U, Ma CK, Shaw A. Signet ring variant of lobular carcinoma of the breast: a clinicopathologic and immunohistochemical study. Mod. Pathol. 1993; 6: 516–20. 5 Abid A, Moffa C, Monga DK. Breast cancer metastasis to the GI tract may mimic primary gastric cancer. J. Clin. Oncol. 2013; 31: 106–7.
© 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society
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A 57-year-old woman who had undergone surgery for breast cancer 5 years earlier continued to undergo endocrine therapy and chemotherapy for metastasis to the liver. She developed epigastric discomfort with elevated serum concentrations of CA15-3 and NCC-ST439. Esophagogastroduodenoscopy showed multiple minute discolored depressions surrounded by slightly reddish mucosa in the stomach (Fig. 1a,b). Magnifying endoscopy with narrow-band imaging (ME-NBI) revealed increased tortuous dilated microvessels in the surrounding mucosa. Within the discolored depression, however, microvessels were fine and sparse, and microsurface structure was absent (Fig. 1c,d). Endoscopic mucosal biopsy specimens taken from the lesions showed a poorly differentiated adenocarcinoma with signet-ring cell morphology (Fig. 2a), and immunohistochemical analysis was positive for estrogen receptor, progesterone receptor, and mammaglobin, but negative for E-cadherin (Fig. 2b–e). Because these pathological findings were compatible with lobular breast carcinoma, the gastric lesions were diagnosed as metastases from breast cancer. 18 F-fluorodeoxyglucose positron emission tomography/computed tomography revealed liver metastasis, but did not detect gastric metastasis. Her chemotherapy regimen was changed. Lobular carcinoma has a high tendency to metastasize to the gastrointestinal tract, especially to the upper gastrointestinal tract.1,2 The most frequent type of breast cancer metastasis to the stomach as seen on endoscopy is linitis plastica with thickened folds and tumor infiltration in the deep layers,1 although
Letters, Techniques and Images
713
Gastric metastasis from breast cancer visualized by magnifying endoscopy with narrow-band imaging
Figure 1 (a,b) White light endoscopy shows multiple minute discolored depressions surrounded by slightly reddish mucosa in the stomach. (c,d) Magnifying endoscopy with narrow-band imaging reveals increased tortuous dilated microvessels in the surrounding mucosa. Within the discolored depression, however, microvessels are fine and sparse, and microsurface structure is absent.
Figure 2 (a) Histopathology of endoscopic mucosal biopsy specimens taken from the lesions show a poorly differentiated adenocarcinoma with signet-ring cell morphology (hematoxylin and eosin, ×200). (b–e) Immunohistochemical analysis reveals that the lesions are positive for estrogen receptor (b, ×100), progesterone receptor (c, ×100), and mammaglobin (d, ×100), but negative for E-cadherin (e, ×100).
the gastric metastasis sometimes resembles early gastric cancer.3 Because lobular carcinoma may produce a signet-ring cell morphology,4 gastric metastasis of lobular carcinoma is often difficult to differentiate from primary gastric signet-ring cell carcinoma.3–5 To our knowledge, this is the first report of gastric metastases of lobular breast carcinoma visualized by ME-NBI. The ME-NBI findings were different from those of gastric cancer. Thus, ME-NBI may be useful for the differential diagnosis of gastric metastases of lobular breast carcinoma. Authors declare no conflict of interests for this article. Yohei Waseda, Tomoyuki Hayashi and Shuichi Kaneko Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan doi: 10.1111/den.12499
REFERENCES 1 Taal BG, Peterse H, Boot H. Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma. Cancer 2000; 89: 2214–21. 2 Almubarak MM, Laé M, Caucheux W et al. Gastric metastasis of breast cancer: a single centre retrospective study. Dig. Liver Dis. 2011; 43: 823–7. 3 Kudo T, Matsumoto T, Nakamura S et al. Solitary minute metastasis from breast cancer mimicking primary intramucosal gastric signet-cell cancer. Gastrointest. Endosc. 2005; 62: 139–40. 4 Raju U, Ma CK, Shaw A. Signet ring variant of lobular carcinoma of the breast: a clinicopathologic and immunohistochemical study. Mod. Pathol. 1993; 6: 516–20. 5 Abid A, Moffa C, Monga DK. Breast cancer metastasis to the GI tract may mimic primary gastric cancer. J. Clin. Oncol. 2013; 31: 106–7.
© 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society
bs_bs_banner
A 57-year-old woman who had undergone surgery for breast cancer 5 years earlier continued to undergo endocrine therapy and chemotherapy for metastasis to the liver. She developed epigastric discomfort with elevated serum concentrations of CA15-3 and NCC-ST439. Esophagogastroduodenoscopy showed multiple minute discolored depressions surrounded by slightly reddish mucosa in the stomach (Fig. 1a,b). Magnifying endoscopy with narrow-band imaging (ME-NBI) revealed increased tortuous dilated microvessels in the surrounding mucosa. Within the discolored depression, however, microvessels were fine and sparse, and microsurface structure was absent (Fig. 1c,d). Endoscopic mucosal biopsy specimens taken from the lesions showed a poorly differentiated adenocarcinoma with signet-ring cell morphology (Fig. 2a), and immunohistochemical analysis was positive for estrogen receptor, progesterone receptor, and mammaglobin, but negative for E-cadherin (Fig. 2b–e). Because these pathological findings were compatible with lobular breast carcinoma, the gastric lesions were diagnosed as metastases from breast cancer. 18 F-fluorodeoxyglucose positron emission tomography/computed tomography revealed liver metastasis, but did not detect gastric metastasis. Her chemotherapy regimen was changed. Lobular carcinoma has a high tendency to metastasize to the gastrointestinal tract, especially to the upper gastrointestinal tract.1,2 The most frequent type of breast cancer metastasis to the stomach as seen on endoscopy is linitis plastica with thickened folds and tumor infiltration in the deep layers,1 although
