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186 SIMULTANEOUS SIGNET RING CARCINOMAS IN STOMACH AND BREAST - WHICH IS THE PRIMARY? WITH REVIEW OF LITERATURE A Xuan, K Croitoru AIM: We describe a highly unusual case of invasive ductal carcinoma of the breast mimicking gastric signet ring cell carcinoma in multiple clinical, endoscopic, and pathological aspects. Relevant literature is also reviewed and presented.
Division of Gastroenterology, McMaster University, Hamilton, Ontario
CASE: A 34-year-old Hispanic female presented to the ER several times over two months with intractable nausea, vomiting, and an inability to tolerate oral intake despite multiple attempts of medical treatment. On upper endoscopy, a large, atypical appearing ulcer in the gastric body was discovered. Biopsy revealed a signet ring cell adenocarcinoma. At staging laparoscopy there was evidence of intra-abdominal metastasis. She subsequently was transferred to the regional cancer centre to undergo systemic chemotherapy. Shortly after, she complained of a small lump in her left breast that had become noticeable to her for only two weeks. Biopsy of this breast lesion showed signet ring cell adenocarcinoma with identical molecular features as the gastric lesion. This extremely rare presentation was jointly reviewed by experts, and based on radiological and clinical features, a primary lesion from the breast was favoured.
DISCUSSION: This extraordinary case stands out even among the small number of reported cases in the literature describing gastric metastasis of breast primary:
Almost in all cases, the breast primaries are either locally advanced or the metastases occurred some time after. However, in this patient the primary was not only inconspicuous, also the metastasis was nearly synchronous.
Most metastatic breast cancers to the GI track are lobular in origin (~5%). It is exceedingly rare for ductal cancer, as was in this case, to metastasize to the gastrointestinal organs.
CONCLUSION: This truly one-of-a-kind case underscores the importance of full functional inquiry even after the diagnosis of a plausible GI cancer. In this patient, identification of the true primary site allowed the chemotherapy regimen to be modified and optimized, which possibly led to an improved survival.