title: Synchronous gastric and colonic metastases of invasive lobular breast carcinoma: case report and review of the literature.
abstract: Breast cancer is the most common malignancy in women and the main cause of cancer death in the UK. Gastrointestinal (GI) tract metastasis and carcinomatosis from primary breast cancer are rare but breast cancer is the second most common primary malignancy to metastasise to the GI tract  after malignant melanoma. The metastatic patterns of invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) have been shown to differ considerably. Liver, lung and brain metastases are more common in IDC. Most series report a greater prediliction for lobular carcinoma to metastasise  to the GI tract, gynaecological organs or peritoneum.  The presentation of GI metastasis due to breast cancer is typically vague and the clinical, radiological, endoscopic and histopathologic findings are often difficult to distinguish from primary gastric carcinoma. Such a patient is more  likely to present to a luminal surgeon or gastroenterologist than a breast surgeon. Therefore a high index of clinical suspicion with early endoscopy in those with non-specific symptoms and a past history of breast cancer, particularly ILC, are recommended.  It is imperative to differentiate  between metastatic breast cancer and primary gastric carcinoma as treatment strategies differ hugely. Therefore, correlation of endoscopic biopsy histology with the primary breast cancer histology is essential. Treatment modalities are limited to appropriate systemic therapy, which may have  a palliative effect in up to 50%. Surgical intervention is nearly always limited to palliative bypass only. Prognosis is consistent with the median survival of all women with metastatic disease secondary to breast cancer.
authors.affiliation: Department of General Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK. adamcritchley@doctors.net.uk
authors.forename: Adam Charles
authors.initials: AC
authors.lastname: Critchley
authors.forename: James
authors.initials: J
authors.lastname: Harvey
authors.forename: Michael
authors.initials: M
authors.lastname: Carr
authors.forename: Obi
authors.initials: O
authors.lastname: Iwuchukwu
mesh_terms: D001943:Breast Neoplasms; D018275:Carcinoma, Lobular / Q000556:secondary*; D003110:Colonic Neoplasms / Q000556:secondary*; D005260:Female; D006801:Humans; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000556:secondary*