[Diffuse mucosal gastric and coecal metastasis from occult breast cancer].
METHODS
A slightly confused and apathic 78-year-old woman presented in a deteriorating general condition and unspecific symptoms with (diarrhea, vomiting, nausea).


METHODS
Laboratory tests revealed megalocytic anemia with vitamin B12 deficiency. As a cause, atrophic gastritis was suspected. Esophagogastroduodenoscopy with multiple "gastric mapping" biopsies revealed diffuse infiltration by an adenocarcinoma in 12 out of 14 gastric biopsy sites. Surprisingly, this malignant tissue was identified by immunohistochemistry as a diffuse infiltration by an as yet unrecognized breast cancer. Immunohistochemically identical infiltrations were identified in the cecum by colonoscopy.


METHODS
Subsequent mammography identified a retromammilar primary tumor in the right breast. Because of the patient's poor general condition merely palliative therapy with oral tamoxifen was initiated.


CONCLUSIONS
The correct diagnosis and appropriate therapy of gastric and coecal metastases secondary to an as yet unrecognized breast cancer were rendered possible only by additional immunohistochemical testing with specific antibodies against the estrogen receptor, cytoceratin (CK) 20 and 7 and E-cadherin.
Klinik für Gastroenterologie, Hepatologie und Gastroenterologische Onkologie, Städtisches Klinikum München, Akademisches Lehrkrankenhaus der TU-München.
J
J
Wagner
A
A
Nerlich
W
W
Schepp
D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary*; D000284:Administration, Oral; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology*; D002430:Cecal Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005757:Gastritis, Atrophic / Q000175:diagnosis; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000473:pathology; D008327:Mammography; D010166:Palliative Care; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D013629:Tamoxifen / Q000008:administration & dosage
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen