A 59‐year‐old white woman with a history of breast cancer presented with a 3‐day history of sharp, crampy right lower abdominal pain, radiating to the left lower quadrant and associated with nonbloody diarrhea and vomiting. She was diagnosed with ductal carcinoma in situ in her right breast and had a right mastectomy in 1991. The cancer recurred multiple times and was treated with left mastectomy, various chemotherapy regimen, and radiation therapy. She was started on trial of Hercep‐tin/lapatinib 6 months prior to admission and had received her last therapy 2 days prior to admission. Review of systems was negative. Her vital signs were normal, and physical exam was unremarkable except for tenderness in the right lower quadrant with decreased bowel sounds. CT of abdomen and pelvis showed mild dilation of the distal small bowel and right colon with no transition point, a small amount of ascites, and no evidence of masses. Given the patient's symptoms and CT findings, diagnosis of ileus was made. The patient was kept on nothing by mouth, a nasogastric tube was placed for decompression, and she had serial obstruction series to monitor her progression. She did not improve clinically, and nutritional support with total parenteral nutrition was instituted. Repeat CT on day 6 showed diffuse dilatation of small bowel without caliber transition and slight increase in ascites. Colonoscopy was attempted but was unsuccessful, as the scope was unable to advance past the tortuous sigmoid. Paracentesis was obtained to evaluate the possibility of carcinomatosis. Cytology analysis from ascitic fluid revealed neoplastic cells reacting strongly with immunohistological markers for breast carcinoma. On day 15 of admission, exploratory laparotomy was performed. A large tumor was found obstructing the transverse colon. Surgical bypass was created, as the tumor was unresectable. Surgical biopsy specimen confirmed adenocarinoma morphologically consistent with the neoplastic cells from ascitic fluid.
The most frequent sites of metastasis of breast cancer are liver, lungs, brain, and bones. Diagnosis of breast cancer metastasis is rarely seen, as documented in few case reports; however, a recent study showed that 8% of breast cancer patients had some colonic involvement. This shows that such a diagnosis can be often missed. We should be more vigilant when evaluating a patient with breast cancer history who presents with gastrointestinal symptoms mimicking various diseases such as inflammatory bowel disease, ileus, and diverticulitis. This case also shows relying on imaging studies alone can also delay the diagnosis. Early diagnosis can lead to early treatment with chemotherapy.
Patients with breast cancer history who present with symptoms mimicking various gastrointestinal disorders should be considered for possible intra‐abdominal meta‐static lesions regardless of definitive mass confirmation on imaging.
M. Patel ‐ none; J. Lee‐Woo ‐ none; F. Urbano ‐ none; E. Cerceo ‐ none
To cite this abstract:Patel M, Lee W, Urbano F, Cerceo E. Rare Case of Breast Cancer Metastasis to Colon. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 362. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/rare-case-of-breast-cancer-metastasis-to-colon/. Accessed April 10, 2020.