Obstructive colon metastases from lobular breast cancer: report of a case and review  of the literature.
BACKGROUND
Gastrointestinal metastases from breast cancer are rare. One large series reported a rate of 0.7% of gastrointestinal metastatic manifestations from breast cancer, but its true incidence could be underestimated. Here we report a case of bowel obstruction caused by sigmoid metastases from breast cancer and describe its relevance to histological origin and clinical practice.


METHODS
The clinical course and histopathology of the case are reviewed and compared with reports of similar cases in the literature.


RESULTS
An 80-year-old woman presented with bowel obstruction. Her medical history included infiltrating lobular breast cancer treated with left radical mastectomy 25 years before the current presentation; 13 years later bone metastases developed and were treated with hormone therapy. In 2003 the patient came to our emergency department because of symptoms of bowel obstruction. A computed tomography (CT) scan revealed a mass in the distal sigmoid causing the obstruction. A colostomy was performed, followed by a second operation completed with Hartmann's procedure. Histological examination revealed metastases from invasive lobular carcinoma. The patient was discharged 45 days postoperatively and died 9 months later because of disease progression.


CONCLUSIONS
Although gastrointestinal metastases from breast cancer are rare, patients with diagnosed breast cancer, particularly invasive lobular carcinoma, should be regularly followed up with endoscopy, CT, endosonography and PET-CT when abdominal symptoms are present. This could permit early diagnosis of gastrointestinal metastases and improve treatment planning.
Department of Digestive and Colorectal Surgery, Center of Minimally Invasive Surgery, University of Turin, Molinette Hospital, Corso A.M. Dogliotti 14, Turin, Italy. mistrangelo@katamail.com
Massimiliano
M
Mistrangelo
Paola
P
Cassoni
Marinella
M
Mistrangelo
Isabella
I
Castellano
Elena
E
Codognotto
Anna
A
Sapino
Ginevra
G
Lamanna
Francesca
F
Cravero
Lavinia
L
Bianco
Gianluca
G
Fora
Sergio
S
Sandrucci
D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000556:secondary* / Q000601:surgery; D003125:Colostomy; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D012811:Sigmoid Neoplasms / Q000150:complications* / Q000556:secondary* / Q000601:surgery