1
|
Yu W, Zhang Q, Ali M, Chen B, Yang Y, Wang L, Sun Q, Wang Y, Wang D. A nomogram for predicting the recurrence of small bowel obstruction after gastrectomy in patients with gastric cancer. World J Surg Oncol 2023; 21:351. [PMID: 37946228 PMCID: PMC10633924 DOI: 10.1186/s12957-023-03197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND This study aimed to create a nomogram for predicting the recurrence of small bowel obstruction (SBO) after gastrectomy in patients with gastric cancer (GC) in order to provide better guidance for its diagnosis and treatment. METHODS A total of 173 patients undergone gastrectomy and developed SBO from January 2015 to October 2022 were admitted into this case-control study. The risk factors of postoperative recurrent SBO were analyzed by univariate and multivariate regression, and a nomogram for predicting the recurrent SBO after gastrectomy was developed using R Studio. RESULTS Thirty-nine cases of postoperative recurrent SBO occurred among the 173 GC patients who underwent radical gastrectomy, and the percentage of recurrent SBO was 22.54% (39/173). Age [odds ratio (OR) = 0.938, p = 0.026], WBC count (OR = 1.547, p < 0.001), tumor size (OR = 1.383, p = 0.024), postoperative metastasis (OR = 11.792, p = 0.030), and the interval from gastrectomy to first SBO (OR = 1.057, p < 0.001) were all identified as independent risk factors for postoperative recurrent SBO by logistic regression analysis. The receiver operating characteristic curve, the calibration curve, the model consistency index, and the decision curve analysis showed that the nomogram had good predictive performance. CONCLUSION Based on these factors, we created a nomogram to predict the occurrence of postoperative recurrent SBO. This novel nomogram could serve as a crucial early warning indicator that would guide doctors to make informed decisions while managing patients with gastric cancer.
Collapse
Grants
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
Collapse
Affiliation(s)
- Wenhao Yu
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Qi Zhang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Muhammad Ali
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Bangquan Chen
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Yapeng Yang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Liuhua Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Qiannan Sun
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Yong Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China.
- Medical College of Yangzhou University, Yangzhou, China.
| |
Collapse
|
2
|
Yang SY, Zhang J, Yang ZQ, Duan JJ, Zhang Y, Li MK, Wang L, Ye CM, Nie JY. Advanced hormone receptor-positive/human epidermal growth factor receptor 2-positive invasive ductal carcinoma with cecal metastasis: A case report. Sci Prog 2023; 106:368504231201043. [PMID: 37828835 PMCID: PMC10576924 DOI: 10.1177/00368504231201043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
The incidence of gastrointestinal metastases from breast cancer (BC) is low. We report a special case of Luminal B (Hormone Receptor positive [HR+]/Human Epidermal Growth Factor receptor 2-positive [HER-2+]) BC. The patient presented with asymptomatic brain metastases two years after radical surgery for modified breast cancer and developed right lower abdominal pain during relief therapy. Electronic gastroenteroscopy revealed inflammatory changes in the cecal mucosa. These changes were confirmed on pathology to be cecal metastasis from BC. The patient's condition was stabilised after treatment with an antibody-drug conjugate (ADC). For patients with BC who develop appendicitis-like symptoms after treatment for invasive ductal carcinoma of the breast, clinicians should be fully aware that the possibility of cecal metastasis needs to be considered, despite the very low probability of occurrence.
Collapse
Affiliation(s)
- Si-Yuan Yang
- The Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
- Kunming Medical University, Kunming, China
| | - Ji Zhang
- The Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Zhuang-Qing Yang
- The Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
- Kunming Medical University, Kunming, China
| | - Jia-Jun Duan
- The Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Ying Zhang
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Yunnan Province, Kunming, China
| | - Ming-Ke Li
- Department of Digestive Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lei Wang
- The Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Chun-mei Ye
- The Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Jian-Yun Nie
- The Third Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| |
Collapse
|
3
|
Bolzacchini E, Nigro O, Inversini D, Giordano M, Maconi G. Intestinal metastasis from breast cancer: Presentation, treatment and survival from a systematic literature review. World J Clin Oncol 2021; 12:382-392. [PMID: 34131569 PMCID: PMC8173325 DOI: 10.5306/wjco.v12.i5.382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/23/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intestinal metastases from breast cancer (BC) arerare; available data depend mainly on case reports and case series.
AIM To conduct a review of the literature regarding presentation, diagnosis, treatment and survival of patients with intestinal metastasis from BC.
METHODS We identified all articles that described patients with intestinal metastasis (from duodenum to anum) from BC using MEDLINE (1975 to 2020) and EMBASE (1975 to 2020) electronic databases.
RESULTS We found 96 cases of intestinal metastasis of BC. Metastasization involved large bowel (cecum, colon, sigmoid, rectum) (51%), small bowel (duodenum, jejunum, ileum) (49%), and anum (< 1%). Median age of patients was 61-years. The most frequent histology was infiltrating lobular carcinoma followed by infiltrating ductal carcinoma. In more than half of patients, the diagnosis was made after the diagnosis of BC (median: 7.2 years) and in many cases of emergency, for bowel obstruction, bleeding or perforation. Diagnosis was achieved through endoscopy, radiological examination or both. In most of the cases, patients underwent surgery with or without systemic therapies. Survival of patients included in this review was available in less than 50% of patients and showed an overall median of 12 mo since diagnosis of the intestinal metastasis.
CONCLUSION Although, intestinal metastases of BC are considered a rare condition, clinicians should consider the possibility of intestinal involvement in case of abdominal symptoms even in acute setting and many years after the diagnosis of BC, especially in patients with a histology of lobular carcinoma.
Collapse
Affiliation(s)
- Elena Bolzacchini
- Department of Oncology, Ospedale Sant' Anna, ASST Lariana, Como 22100, Italy, Department of Medicine and Surgery, University of Insubria, Varese 21100, Italy
| | - Olga Nigro
- Department of Oncology, Ospedale di Circolo ASST-Sette Laghi, Varese 21100, Italy
| | - Davide Inversini
- Department of General Surgery, Ospedale Sant' Antonio Abate, ASST Lariana, Cantu' 22100, Italy
| | - Monica Giordano
- Department of Oncology, Ospedale Sant' Anna, ASST Lariana, Como 22100, Italy
| | - Giovanni Maconi
- Department of Biomedical and Clinical Sciences, Gastroenterology Unit, "Luigi Sacco" University Hospital, Milano 20157, Italy
| |
Collapse
|
4
|
Sehrawat A, Kotwal SA, Gupta D. Colonic Metastases from a Luminal A Type Invasive Ductal Carcinoma Breast: A Rare Case Report. Indian J Med Paediatr Oncol 2021. [DOI: https://doi.org/10.4103/ijmpo.ijmpo_109_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AbstractMetastatic carcinoma breast involving hepatobiliary system and peritoneum is a common and well-described entity. However, colonic luminal involvement by breast metastases is rare and its early recognition is important for accurate management planning. We report a case of an elderly woman with luminal A type invasive ductal carcinoma (IDC) breast, initially controlled/stabilized on hormonal treatment and later progressed to involve colon presenting with intestinal obstructive symptoms. Lobular carcinoma breast which constitutes around 10% of breast cancers is more likely to have gastrointestinal tract (GIT) involvement. On the other hand, GIT metastasis from IDC breast is quite rare. Given the progressively increasing survival with current and forthcoming novel treatment modalities, it is very important to recognize and understand unusual presentation of metastatic breast cancer, such as colonic metastasis, for timely treatment planning and implementation.
Collapse
Affiliation(s)
- Amit Sehrawat
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sumedha Ahal Kotwal
- Department of Pathology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
| | - Deni Gupta
- Department of Medical Oncology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
| |
Collapse
|
5
|
Sehrawat A, Kotwal SA, Gupta D. Colonic Metastases from a Luminal A Type Invasive Ductal Carcinoma Breast: A Rare Case Report. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_109_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractMetastatic carcinoma breast involving hepatobiliary system and peritoneum is a common and well-described entity. However, colonic luminal involvement by breast metastases is rare and its early recognition is important for accurate management planning. We report a case of an elderly woman with luminal A type invasive ductal carcinoma (IDC) breast, initially controlled/stabilized on hormonal treatment and later progressed to involve colon presenting with intestinal obstructive symptoms. Lobular carcinoma breast which constitutes around 10% of breast cancers is more likely to have gastrointestinal tract (GIT) involvement. On the other hand, GIT metastasis from IDC breast is quite rare. Given the progressively increasing survival with current and forthcoming novel treatment modalities, it is very important to recognize and understand unusual presentation of metastatic breast cancer, such as colonic metastasis, for timely treatment planning and implementation.
Collapse
Affiliation(s)
- Amit Sehrawat
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sumedha Ahal Kotwal
- Department of Pathology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
| | - Deni Gupta
- Department of Medical Oncology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
| |
Collapse
|
6
|
Meekel JP, Coblijn UK, Flens MJ, Muller S, Boer den FC. Small bowel obstruction caused by 18FDG-negative ileocecal metastasis of lobular breast carcinoma. J Surg Case Rep 2020; 2020:rjaa167. [PMID: 32760483 PMCID: PMC7394128 DOI: 10.1093/jscr/rjaa167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 12/21/2022] Open
Abstract
Breast carcinoma is the most frequently diagnosed cancer in women. In up to 30%, distant metastases will occur; however, ileocecal metastases are rare. Although there have been cases reported that demonstrate ileocecal metastases of breast carcinoma, PET/CT-negative cases have never been described. We present a patient with a small bowel obstruction, preoperatively complicated by pulmonary embolisms. The patient underwent placement of an inferior vena cava filter followed by hemicolectomy. Pathological examination revealed ileocecal lobular breast carcinoma metastases and adjacent peritoneal carcinomatosis, which had shown no intestinal 18FDG uptake 7 weeks prior to presentation. Subsequently, symptoms of metastases and the paraneoplastic syndrome progressed, and the patient was referred to the medical oncologist for palliative therapy. Although uncommon, physicians should be aware of potential presence of 18FDG-negative gastrointestinal metastases of breast cancer.
Collapse
Affiliation(s)
- Jorn P Meekel
- Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.,Department of Vascular Surgery, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Usha K Coblijn
- Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.,Department of Vascular Surgery, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Marcel J Flens
- Department of Pathology, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Sandra Muller
- Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Frank C Boer den
- Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.,Department of Vascular Surgery, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Sarfraz H, Chen D, Muhsen IN, Schwartz MR, Ogbonna M. Breast Cancer Metastasis Masquerading as a Primary Gynecological / Colonic Malignancy: A Rare Diagnostic Conundrum. Cureus 2020; 12:e7806. [PMID: 32467783 PMCID: PMC7249773 DOI: 10.7759/cureus.7806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Breast cancer is the most common malignancy affecting women. Metastatic involvement of the gastrointestinal (GI) tract secondary to a primary breast malignancy is rare. Here, we describe the case of a 60-year-old woman with a history of right lobular breast cancer (diagnosed and treated five years prior to presentation) who presented with fatigue, generalized abdominal pain, distension, weight loss, and vomiting. Her initial imaging was suspicious for a primary gynecological malignancy; however, subsequent workup showed a colonic mass. Total colonoscopy revealed colon metastases, and an immunohistochemical profile favored invasive lobular carcinoma of breast. Most cases of gastrointestinal metastases from breast cancer have lobular histology; however, colonic involvement is rare.
Collapse
Affiliation(s)
| | - Diana Chen
- Internal Medicine, Houston Methodist Hospital, Houston, USA
| | | | | | | |
Collapse
|
8
|
Sehrawat A, Kotwal SA, Gupta D. Colonic Metastases from a Luminal A Type Invasive Ductal Carcinoma Breast: A Rare Case Report. Indian J Med Paediatr Oncol 2020. [DOI: https:/doi.org/10.4103/ijmpo.ijmpo_109_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AbstractMetastatic carcinoma breast involving hepatobiliary system and peritoneum is a common and well-described entity. However, colonic luminal involvement by breast metastases is rare and its early recognition is important for accurate management planning. We report a case of an elderly woman with luminal A type invasive ductal carcinoma (IDC) breast, initially controlled/stabilized on hormonal treatment and later progressed to involve colon presenting with intestinal obstructive symptoms. Lobular carcinoma breast which constitutes around 10% of breast cancers is more likely to have gastrointestinal tract (GIT) involvement. On the other hand, GIT metastasis from IDC breast is quite rare. Given the progressively increasing survival with current and forthcoming novel treatment modalities, it is very important to recognize and understand unusual presentation of metastatic breast cancer, such as colonic metastasis, for timely treatment planning and implementation.
Collapse
Affiliation(s)
- Amit Sehrawat
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sumedha Ahal Kotwal
- Department of Pathology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
| | - Deni Gupta
- Department of Medical Oncology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
| |
Collapse
|
9
|
Screening Colonoscopy Unmasking Colonic Metastasis from an Occult Breast Ductal Carcinoma: A Case Report and Review of the Literature. Case Rep Oncol Med 2019; 2019:8432079. [PMID: 30918733 PMCID: PMC6408989 DOI: 10.1155/2019/8432079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 02/12/2019] [Indexed: 12/30/2022] Open
Abstract
Metastatic spread from breast cancer to the gastrointestinal tract is rare. Such cases are predominantly lobular carcinomas and they usually occur later on during the course of disease progression with the stomach being the most common site involved. Furthermore, occult breast primary tumor is extremely uncommon. To the best of our knowledge, we describe here the first case of incidental colonic metastasis as first presentation of an occult breast ductal carcinoma. We also provide a review of the literature on gastrointestinal—and specifically colonic—involvement from breast ductal carcinoma.
Collapse
|
10
|
Galanopoulos M, Gkeros F, Liatsos C, Pontas C, Papaefthymiou A, Viazis N, Mantzaris GJ, Tsoukalas N. Secondary metastatic lesions to colon and rectum. Ann Gastroenterol 2018; 31:282-287. [PMID: 29720853 PMCID: PMC5924850 DOI: 10.20524/aog.2018.0244] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/15/2018] [Indexed: 12/19/2022] Open
Abstract
Metastatic lesions of the colon are a rare clinical entity that may present difficulties in management. The incidence of these metastases appears to be increasing, as a result of physicians' greater awareness during follow-up investigations of a primary neoplasm. Furthermore, the presence of a greater proportion of these abnormalities at autopsy should be a triggering factor for further investigation for doctors dealing with colorectal oncology. Their clinical presentation may vary from asymptomatic to signs similar to those of colorectal cancer. However, immunohistological analysis is considered the cornerstone for differentiating metastases to the colon, originating from other primaries, from primary colorectal neoplasms. Survival reports and treatment options vary. This article concisely presents the main characteristics of the secondary lesions to the colon from neoplasms that metastasize to the large intestine (namely, lung, ovary, breast, prostate, kidney, and melanoma) focusing on their incidence, their clinical presentation and the workup investigation. Physicians aware of this uncommon entity are much better prepared to apply an efficient diagnosis and workup, as well as an appropriate treatment strategy.
Collapse
Affiliation(s)
- Michail Galanopoulos
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Filippos Gkeros
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Christos Liatsos
- Department of Gastroenterology, 401 General Military Hospital of Athens (Christos Liatsos), Athens, Greece
| | - Christos Pontas
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Apostolis Papaefthymiou
- Department of Internal Medicine, 401 General Military Hospital of Athens (Apostolis Papaefthymiou), Athens, Greece
| | - Nikos Viazis
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Gerassimos J Mantzaris
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Nikolaos Tsoukalas
- Department of Medical Oncology, Veterans Hospital (417 NIMTS) (Nikolaos Tsoukalas), Athens, Greece
| |
Collapse
|
11
|
Villa Guzmán JC, Espinosa J, Cervera R, Delgado M, Patón R, Cordero García JM. Gastric and colon metastasis from breast cancer: case report, review of the literature, and possible underlying mechanisms. BREAST CANCER-TARGETS AND THERAPY 2016; 9:1-7. [PMID: 28096693 PMCID: PMC5207330 DOI: 10.2147/bctt.s79506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Gastrointestinal metastases from breast cancer are not common. We present a 58-year-old female diagnosed with lobular breast cancer some years before whose relapses were gastric and colonic mucosal. Simultaneous metastases are extremely rare. To our knowledge, no cases of initial dual affectation have been reported. The patient also showed gastritis by Helicobacter pylori. Invasive lobular breast carcinoma is the most frequent special type of breast cancer and carries some specific molecular alterations such as loss of expression of E-cadherin. Although underlying mechanisms of metastasization are not entirely known, chemokines as well as inflammatory events seem to be implicated in this process. Interaction between chemokines and their receptors frequently induces cell migration. We hypothesize that H. pylori, inflammatory cells, and chemokines may create a favorable environment attracting tumor cells.
Collapse
Affiliation(s)
| | | | | | | | - R Patón
- Department of Gastroenterology
| | - J M Cordero García
- Department of Nuclear Medicine, University Ciudad Real General Hospital, Ciudad Real, Spain
| |
Collapse
|
12
|
Park GS, Kim JH. Myeloid differentiation primary response gene 88-leukotriene B4 receptor 2 cascade mediates lipopolysaccharide-potentiated invasiveness of breast cancer cells. Oncotarget 2016; 6:5749-59. [PMID: 25691060 PMCID: PMC4467399 DOI: 10.18632/oncotarget.3304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/02/2015] [Indexed: 12/25/2022] Open
Abstract
Inflammation and local inflammatory mediators are inextricably linked to tumor progression through complex pathways in the tumor microenvironment. Lipopolysaccharide (LPS) exposure to tumor cells has been suggested to promote tumor invasiveness and metastasis. However, the detailed signaling mechanism involved has not been elucidated. In this study, we showed that LPS upregulated the expression of leukotriene B4 receptor-2 (BLT2) and the synthesis of BLT2 ligands in MDA-MB-231 and MDA-MB-435 breast cancer cells, thereby promoting invasiveness. BLT2 depletion with siRNA clearly attenuated LPS-induced invasiveness. In addition, we demonstrated that myeloid differentiation primary response gene 88 (MyD88) lies upstream of BLT2 in LPS-potentiated invasiveness and that this ‘MyD88-BLT2’ cascade mediates activation of NF-κB and the synthesis of IL-6 and IL-8, which are critical for the invasiveness and aggression of breast cancer cells. LPS-driven metastasis of MDA-MB-231 cells was also markedly suppressed by the inhibition of BLT2. Together, our results demonstrate, for the first time, that LPS potentiates the invasiveness and metastasis of breast cancer cells via a ‘MyD88-BLT2’-linked signaling cascade.
Collapse
Affiliation(s)
- Geun-Soo Park
- College of Life Sciences and Biotechnology, Korea University, Seoul, Korea
| | - Jae-Hong Kim
- College of Life Sciences and Biotechnology, Korea University, Seoul, Korea
| |
Collapse
|
13
|
Molina-Barea R, Rios-Peregrina RM, Slim M, Calandre EP, Hernández-García MD, Jimenez-Rios JA. Lobular breast cancer metastasis to the colon, the appendix and the gallbladder. ACTA ACUST UNITED AC 2015; 9:428-30. [PMID: 25759626 DOI: 10.1159/000368430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metastases of lobular breast cancer are commonly encountered at the level of lungs, bones, brain and liver, whereas lesions in the gastrointestinal tract are rarely seen. CASE REPORT A case of a patient with metastases in the right colon and gallbladder originating from an invasive lobular carcinoma is described. CONCLUSION Adequate diagnostic procedures should be performed in patients with a history of breast cancer and who show gastrointestinal symptoms to rule out the potential presence of gastrointestinal metastases.
Collapse
Affiliation(s)
- Rocio Molina-Barea
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario 'San Cecilio', Granada, Spain
| | | | - Mahmoud Slim
- Instituto de Neurociencias, Universidad de Granada, Spain
| | | | - Maria D Hernández-García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario 'San Cecilio', Granada, Spain
| | - José A Jimenez-Rios
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario 'San Cecilio', Granada, Spain
| |
Collapse
|
14
|
Calò PG, Fanni D, Ionta MT, Medas F, Faa G, Atzori F. Jejunal Obstruction Caused by Metastasis from an Undiagnosed Breast Cancer: A Case Report. TUMORI JOURNAL 2012. [DOI: 10.1177/030089161209800327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Solitary metastasis from breast carcinoma to the gastrointestinal tract is an uncommon finding. We describe a female patient with a solitary jejunal metastasis from an undiagnosed breast cancer who presented to the emergency department with a bowel obstruction. Abdominal surgery was performed, revealing a jejunal stenosis from a metastatic lobular carcinoma. The primary tumor in the left breast was subsequently diagnosed and surgically removed.
Collapse
Affiliation(s)
- Pietro Giorgio Calò
- Dipartimento di Chirurgia e Scienze
Odontostomatologiche, Università degli Studi di Cagliari, Cagliari, Italy
| | - Daniela Fanni
- Unità operativa Complessa di Anatomia
Patologica, AOU Cagliari, Università degli Studi di Cagliari, Cagliari, Italy
| | - Maria Teresa Ionta
- Unità operativa Complessa di Oncologia
Medica II, AOU Cagliari, Università degli Studi di Cagliari, Cagliari, Italy
| | - Fabio Medas
- Dipartimento di Chirurgia e Scienze
Odontostomatologiche, Università degli Studi di Cagliari, Cagliari, Italy
| | - Gavino Faa
- Unità operativa Complessa di Anatomia
Patologica, AOU Cagliari, Università degli Studi di Cagliari, Cagliari, Italy
| | - Francesco Atzori
- Unità operativa Complessa di Oncologia
Medica II, AOU Cagliari, Università degli Studi di Cagliari, Cagliari, Italy
| |
Collapse
|
15
|
Eljabu W, Finch G, Nottingham J, Vaingankar N. Metastatic deposits of breast lobular carcinoma to small bowel and rectum. Int J Breast Cancer 2011; 2011:413949. [PMID: 22295221 PMCID: PMC3262580 DOI: 10.4061/2011/413949] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/30/2011] [Accepted: 06/01/2011] [Indexed: 12/14/2022] Open
Abstract
Breast cancer is the most frequent malignancy in women accounting for approximately 32% of all cancers, with a lifetime risk of 1 in 10. It causes considerable morbidity and mortality. Recently, the survival rate has dramatically increased due to early detection of the disease and improvement in the treatment measures. However, more than 30% of the patients develop metastatic diseases following surgical treatment, radiotherapy, hormonal therapy, or chemotherapy. Distant spread is usually found in bones, lungs, liver, brain and skin. Rarely, it spreads to bowel, spleen, gallbladder, pancreas, urinary bladder, and eyes. Breast cancer is the second commonest primary tumour responsible for gastrointestinal metastases after malignant melanoma. We report a case of a Caucasian female who developed an intestinal obstruction secondary to metastatic deposits to the small bowel and later to the rectum from breast lobular carcinoma 2 years after mastectomy, axillary clearance, radiotherapy, hormonal therapy, and transverse rectus abdominis myocutaneous (TRAM) flap for reconstruction.
Collapse
Affiliation(s)
- W Eljabu
- Departments of Plastic and Reconstructive Surgery, General Surgery, and Histopathology, Northampton General Hospital, Northampton NN1 5BD, UK
| | | | | | | |
Collapse
|
16
|
Johnson-Holiday C, Singh R, Johnson E, Singh S, Stockard CR, Grizzle WE, Lillard JW. CCL25 mediates migration, invasion and matrix metalloproteinase expression by breast cancer cells in a CCR9-dependent fashion. Int J Oncol 2011; 38:1279-85. [PMID: 21344163 DOI: 10.3892/ijo.2011.953] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 10/04/2010] [Indexed: 01/01/2023] Open
Abstract
Breast cancer (BrCa) is one of the most frequently diagnosed cancers and the second leading cause of cancer-related deaths in North American women. Most deaths are caused by metastasis, and BrCa is characterized by a distinct metastatic pattern involving lymph nodes, bone marrow, lung, liver and brain. Migration of metastatic cells share many similarities with leukocyte trafficking, which are regulated by chemokines and their receptors. The current study evaluates the expression and functional role of CCR9, and its only known ligand, CCL25, in BrCa cell migration and invasion. Quantitative immunohistochemical analysis showed that both moderately and poorly differentiated BrCa tissue expressed significantly more (P<0.0001) CCR9 compared to non-neoplastic breast tissue. Interestingly, poorly differentiated BrCa tissue expressed significantly more (P<0.0001) CCR9 compared to moderately differentiated BrCa tissue. Similarly, CCR9 was highly expressed by the aggressive breast cancer cell line (MDA-MD-231) compared to the less aggressive MCF-7. Migration as well as invasion assays were used to evaluate the functional interaction between CCR9 and CCL25 in BrCa cell lines (MDA-MB-231 and MCF-7). Neutralizing CCR9-CCL25 interactions significantly impaired the migration and invasion of BrCa cells. Furthermore, CCL25 enhanced the expression of MMP-1, -9, -11 and -13 active proteins by BrCa cells in a CCR9-dependent fashion. These studies show CCR9 is functionally and significantly expressed by BrCa (poorly > moderately differentiated) tissue and cells as well as that CCL25 activation of this receptor promotes breast tumor cell migration, invasion and MMP expression, which are key components of BrCa metastasis.
Collapse
Affiliation(s)
- Crystal Johnson-Holiday
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310-1495, USA
| | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
Lobular breast carcinoma represents 2-20% of infiltrative carcinomas of the breast. The incidence of extrahepatic gastrointestinal (GI) tract metastases observed in necropsy studies varies from 6% to 18% and the most commonly affected organ is the stomach, followed by colon and rectum [1-4]. Reported herein is the case of a 67-year-old woman who was primarily diagnosed and surgically treated for a lobular carcinoma of the breast 15 years ago and is now referred with back pain and right hydronephrosis caused by a metastasis in rectum. Frequently, the absence of specific symptoms of digestive metastases of breast cancer leads to a misdiagnosis of this pathology [5-7]. The treatment will be based on a detailed clinical history and histopathological findings. Metastases from breast cancer in GI tract tumours must be excluded in a patient with previous history of breast carcinoma, as in the case reported herein.
Collapse
|