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BREAST CANCER METASTASIS IN THE STOMACH: WHEN THE GASTRECTOMY IS INDICATED ?

Identifieur interne : 000712 ( Pmc/Curation ); précédent : 000711; suivant : 000713

BREAST CANCER METASTASIS IN THE STOMACH: WHEN THE GASTRECTOMY IS INDICATED ?

Auteurs : Marcus Vinicius Rozo Rodrigues ; Valdir Tercioti-Junior ; Luiz Roberto Lopes ; João De Souza Coelho-Neto ; Nelson Adami Andreollo

Source :

RBID : PMC:4944741

Abstract

ABSTRACTBackground:

Breast cancer is the most common malignant neoplasm in the female population. However, stomach is a rare site for metastasis, and can show up many years after initial diagnosis and treatment of the primary tumor.

Aim:

Analyze a case series of this tumor and propose measures that can diagnose it with more precocity.

Methods:

Were analyzed 12 patients with secondary gastric tumors. Immunohistochemistry has demonstrated that primary tumor was breast cancer. We retrieved information of age, histological type, interval between diagnosis of the primary breast cancer and its metastases, immunohistochemistry results, treatment and survival.

Results:

The mean age was 71.3 years (ranging 40-86). Ten cases had already been underwent mastectomy in the moment of the diagnosis of gastric metastasis. Two patients had diagnosis of both primary and secondary tumors concomitantly. At average, diagnosis of gastric metastasis was seven years after diagnosis of primary breast cancer (ranging 0-13). Besides, nine cases had also metastases in other organs, being bones the most affected ones. Immunohistochemistry of the metastases has shown positivity for CK7 antibody in 83.34%, estrogen receptor in 91.67%, progesterone receptor in 66.67% and AE1AE3 antibody in 75%, considering all 12 cases. Moreover, CK20 was absent significantly (66.67%). The positivity of BRST2 marker did not present statistical significance (41.67%). Eight cases were treated with chemotherapy associated or not with hormonal blockade. Surgical treatment of gastric metastasis was performed in four cases: three of them with total gastrectomy and one with distal gastrectomy. Follow-up has shown a mean survival of 14.58 months after diagnosis of metastasis, with only two patients still alive.

Conclusion:

Patients with a history of breast cancer presenting endoscopic diagnosis of gastric cancer it is necessary to consider the possibility of gastric metastasis of breast cancer. The confirmation is by immunohistochemistry and gastrectomy should be oriented in the absence of other secondary involvement and control of the primary lesion.


Url:
DOI: 10.1590/0102-6720201600020005
PubMed: 27438032
PubMed Central: 4944741

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<title>Background:</title>
<p>Breast cancer is the most common malignant neoplasm in the female population. However, stomach is a rare site for metastasis, and can show up many years after initial diagnosis and treatment of the primary tumor. </p>
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<sec>
<title>Aim:</title>
<p>Analyze a case series of this tumor and propose measures that can diagnose it with more precocity. </p>
</sec>
<sec>
<title>Methods:</title>
<p>Were analyzed 12 patients with secondary gastric tumors. Immunohistochemistry has demonstrated that primary tumor was breast cancer. We retrieved information of age, histological type, interval between diagnosis of the primary breast cancer and its metastases, immunohistochemistry results, treatment and survival. </p>
</sec>
<sec>
<title>Results:</title>
<p>The mean age was 71.3 years (ranging 40-86). Ten cases had already been underwent mastectomy in the moment of the diagnosis of gastric metastasis. Two patients had diagnosis of both primary and secondary tumors concomitantly. At average, diagnosis of gastric metastasis was seven years after diagnosis of primary breast cancer (ranging 0-13). Besides, nine cases had also metastases in other organs, being bones the most affected ones. Immunohistochemistry of the metastases has shown positivity for CK7 antibody in 83.34%, estrogen receptor in 91.67%, progesterone receptor in 66.67% and AE1AE3 antibody in 75%, considering all 12 cases. Moreover, CK20 was absent significantly (66.67%). The positivity of BRST2 marker did not present statistical significance (41.67%). Eight cases were treated with chemotherapy associated or not with hormonal blockade. Surgical treatment of gastric metastasis was performed in four cases: three of them with total gastrectomy and one with distal gastrectomy. Follow-up has shown a mean survival of 14.58 months after diagnosis of metastasis, with only two patients still alive. </p>
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<p>Patients with a history of breast cancer presenting endoscopic diagnosis of gastric cancer it is necessary to consider the possibility of gastric metastasis of breast cancer. The confirmation is by immunohistochemistry and gastrectomy should be oriented in the absence of other secondary involvement and control of the primary lesion.</p>
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<name sortKey="Roukos, Dh" uniqKey="Roukos D">DH Roukos</name>
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<name sortKey="Perez, Aa" uniqKey="Perez A">AA Perez</name>
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<author>
<name sortKey="Gomes, Ds" uniqKey="Gomes D">DS Gomes</name>
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<author>
<name sortKey="Gobbi, H" uniqKey="Gobbi H">H Gobbi</name>
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<name sortKey="Whitty, La" uniqKey="Whitty L">LA Whitty</name>
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<name sortKey="Woodland, Jh" uniqKey="Woodland J">JH Woodland</name>
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<author>
<name sortKey="Patel, Jc" uniqKey="Patel J">JC Patel</name>
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<author>
<name sortKey="Nattier, B" uniqKey="Nattier B">B Nattier</name>
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<author>
<name sortKey="Thomas, Cr" uniqKey="Thomas C">CR Thomas</name>
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<name sortKey="Zilberstein, B" uniqKey="Zilberstein B">B Zilberstein</name>
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<name sortKey="Jacob, Ce" uniqKey="Jacob C">CE Jacob</name>
</author>
<author>
<name sortKey="Barchi, Lc" uniqKey="Barchi L">LC Barchi</name>
</author>
<author>
<name sortKey="Yagi, Ok" uniqKey="Yagi O">OK Yagi</name>
</author>
<author>
<name sortKey="Ribeiro Jr, U" uniqKey="Ribeiro Jr U">U Ribeiro-Jr</name>
</author>
<author>
<name sortKey="Coimbra, Bg" uniqKey="Coimbra B">BG Coimbra</name>
</author>
<author>
<name sortKey="Cecconello, I" uniqKey="Cecconello I">I Cecconello</name>
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<name sortKey="Zilberstein, B" uniqKey="Zilberstein B">B Zilberstein</name>
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<name sortKey="Mucerino, Dr" uniqKey="Mucerino D">DR Mucerino</name>
</author>
<author>
<name sortKey="Yagi, Ok" uniqKey="Yagi O">OK Yagi</name>
</author>
<author>
<name sortKey="Ribeiro Junior, U" uniqKey="Ribeiro Junior U">U Ribeiro-Junior</name>
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<name sortKey="Lopasso, Fp" uniqKey="Lopasso F">FP Lopasso</name>
</author>
<author>
<name sortKey="Bresciani, C" uniqKey="Bresciani C">C Bresciani</name>
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<name sortKey="Jacob, Ce" uniqKey="Jacob C">CE Jacob</name>
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<name sortKey="Coimbra, Bgm" uniqKey="Coimbra B">BGM Coimbra</name>
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<name sortKey="Cecconello, I" uniqKey="Cecconello I">I Cecconello</name>
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<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Arq Bras Cir Dig</journal-id>
<journal-id journal-id-type="iso-abbrev">Arq Bras Cir Dig</journal-id>
<journal-id journal-id-type="publisher-id">abcd</journal-id>
<journal-title-group>
<journal-title>Arquivos Brasileiros de Cirurgia Digestiva : ABCD</journal-title>
</journal-title-group>
<issn pub-type="ppub">0102-6720</issn>
<issn pub-type="epub">2317-6326</issn>
<publisher>
<publisher-name>Colégio Brasileiro de Cirurgia Digestiva</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">27438032</article-id>
<article-id pub-id-type="pmc">4944741</article-id>
<article-id pub-id-type="doi">10.1590/0102-6720201600020005</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>BREAST CANCER METASTASIS IN THE STOMACH: WHEN THE GASTRECTOMY IS INDICATED ?</article-title>
<trans-title-group xml:lang="pt">
<trans-title>Metástases gástricas de câncer de mama: quando a gastrectomia está indicada?</trans-title>
</trans-title-group>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>RODRIGUES</surname>
<given-names>Marcus Vinicius Rozo</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>TERCIOTI-JUNIOR</surname>
<given-names>Valdir</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>LOPES</surname>
<given-names>Luiz Roberto</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>COELHO-NETO</surname>
<given-names>João de Souza</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>ANDREOLLO</surname>
<given-names>Nelson Adami</given-names>
</name>
</contrib>
<aff>Discipline of Diseases of the Digestive System and Gastrocentro Unit, Department of Surgery, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil.</aff>
</contrib-group>
<author-notes>
<corresp id="c1">Correspondence: Nelson Adami Andreollo e-mail:
<email>nandreollo@hotmail.com</email>
</corresp>
<fn fn-type="conflict" id="fn2">
<p>Conflicts of interest: none</p>
</fn>
</author-notes>
<pub-date pub-type="epub-ppub">
<season>Apr-Jun</season>
<year>2016</year>
</pub-date>
<pmc-comment>Fake ppub date generated by PMC from publisher pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub">
<season>Apr-Jun</season>
<year>2016</year>
</pub-date>
<volume>29</volume>
<issue>2</issue>
<fpage>86</fpage>
<lpage>89</lpage>
<history>
<date date-type="received">
<day>27</day>
<month>10</month>
<year>2015</year>
</date>
<date date-type="accepted">
<day>26</day>
<month>1</month>
<year>2016</year>
</date>
</history>
<permissions>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License</license-p>
</license>
</permissions>
<abstract>
<title>ABSTRACT</title>
<sec>
<title>Background:</title>
<p>Breast cancer is the most common malignant neoplasm in the female population. However, stomach is a rare site for metastasis, and can show up many years after initial diagnosis and treatment of the primary tumor. </p>
</sec>
<sec>
<title>Aim:</title>
<p>Analyze a case series of this tumor and propose measures that can diagnose it with more precocity. </p>
</sec>
<sec>
<title>Methods:</title>
<p>Were analyzed 12 patients with secondary gastric tumors. Immunohistochemistry has demonstrated that primary tumor was breast cancer. We retrieved information of age, histological type, interval between diagnosis of the primary breast cancer and its metastases, immunohistochemistry results, treatment and survival. </p>
</sec>
<sec>
<title>Results:</title>
<p>The mean age was 71.3 years (ranging 40-86). Ten cases had already been underwent mastectomy in the moment of the diagnosis of gastric metastasis. Two patients had diagnosis of both primary and secondary tumors concomitantly. At average, diagnosis of gastric metastasis was seven years after diagnosis of primary breast cancer (ranging 0-13). Besides, nine cases had also metastases in other organs, being bones the most affected ones. Immunohistochemistry of the metastases has shown positivity for CK7 antibody in 83.34%, estrogen receptor in 91.67%, progesterone receptor in 66.67% and AE1AE3 antibody in 75%, considering all 12 cases. Moreover, CK20 was absent significantly (66.67%). The positivity of BRST2 marker did not present statistical significance (41.67%). Eight cases were treated with chemotherapy associated or not with hormonal blockade. Surgical treatment of gastric metastasis was performed in four cases: three of them with total gastrectomy and one with distal gastrectomy. Follow-up has shown a mean survival of 14.58 months after diagnosis of metastasis, with only two patients still alive. </p>
</sec>
<sec>
<title>Conclusion:</title>
<p>Patients with a history of breast cancer presenting endoscopic diagnosis of gastric cancer it is necessary to consider the possibility of gastric metastasis of breast cancer. The confirmation is by immunohistochemistry and gastrectomy should be oriented in the absence of other secondary involvement and control of the primary lesion.</p>
</sec>
</abstract>
<trans-abstract xml:lang="pt">
<title>RESUMO</title>
<sec>
<title>Racional:</title>
<p>A neoplasia de mama é o tumor maligno mais comum na população feminina tendo o trato gastrointestinal, e mais especificamente o estômago, como local incomum para metástases. </p>
</sec>
<sec>
<title>Objetivo:</title>
<p>Analisar uma série de casos com esse tumor e propor medidas que possam diagnosticá-lo com maior precocidade. </p>
</sec>
<sec>
<title>Métodos:</title>
<p>Foram analisados retrospectivamente 12 pacientes com diagnóstico de neoplasia gástrica secundária a câncer de mama, confirmado por biópsia e imunoistoquímica. Foram analisados idade do diagnóstico, tipo histológico do tumor primário, intervalo de tempo entre o diagnóstico do tumor e a metástase, tratamento e sobrevida. </p>
</sec>
<sec>
<title>Resultados:</title>
<p>A idade média foi de 71,3 anos (40-86 anos). Em média, o diagnóstico da metástase gástrica foi de sete anos após o diagnóstico da lesão primaria (0-13 anos). Nove casos tiveram metástases em outros órgãos, sendo os ossos os locais mais acometidos. Evidenciou-se positividade de anticorpo CK7 em 90,9% casos, receptor de estrógeno em 91,67%, receptor de progesterona em 66,67% e BRST2 em 41,67%. A ausência de CK20 foi de 88,89%. Oito casos foram tratados com quimioterapia associada ou não ao bloqueio hormonal e em quatro foi indicada ressecção cirúrgica sendo em três gastrectomia total e em um caso gastrectomia subtotal. A sobrevida média foi de 14,58 meses. </p>
</sec>
<sec>
<title>Conclusões:</title>
<p>Em doentes com história prévia de câncer de mama apresentando diagnóstico endoscópico de neoplasia gástrica, é necessário considerar a possibilidade de metástase. A confirmação é feita por estudo imunoistoquímico e a gastrectomia deve ser orientada diante da ausência de outros locais de acometimento secundário e controle da lesão primária.</p>
</sec>
</trans-abstract>
<kwd-group>
<title>HEADINGS:</title>
<kwd>Breast Neoplasms</kwd>
<kwd>Neoplasm Metastasis</kwd>
<kwd>Stomach</kwd>
<kwd>Drug therapy</kwd>
<kwd>Gastrectomy</kwd>
</kwd-group>
<counts>
<fig-count count="4"></fig-count>
<table-count count="0"></table-count>
<equation-count count="0"></equation-count>
<ref-count count="27"></ref-count>
<page-count count="4"></page-count>
</counts>
</article-meta>
</front>
</pmc>
</record>

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