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Presented by Ralph Hruban, M.D. and prepared by Maryam Farinola M.D.
Case 4: This woman with a remote history of breast cancer developed severe dyspepsia that did not respond to medical management.
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1. Question
Week 198: Case 4
This woman with a remote history of breast cancer developed severe dyspepsia that did not respond to medical management. A gastrectomy was performed following biopsy.images/met lobular ca 1.jpg
images/met lobular ca 2.jpg
images/met lobular ca 3.jpg
images/met lobular ca 4.jpgCorrect
Answer: Metastatic lobular carcinoma of the breast
Histology: This neoplasm is composed of non-cohesive cells with a signet-ring appearance. A stain for mucin was positive, while immunolabeling for e-cadherin revealed a loss of e-cadherin expression. Immunolabeling for estrogen and progesterone receptors were both positive.
Discussion: Although the majority of neoplasms in the stomach are primary to the stomach, a metastasis should always be included in the differential. Metastatic breast cancer is particularly problematic for two reasons. First, as in this case, the history of breast cancer is often very remote. Breast cancers can metastasize 10 to 20 years after the primary was resected. Second, lobular carcinoma of the breast morphologically mimics diffuse (signet ring cell) gastric cancer. Two things help establish the diagnosis of metastatic breast cancer. The first is thinking of the diagnosis. Second, immunolabeling for breast markers including estrogen and progesterone receptors can help establish the organ of origin.
Incorrect
Answer: Metastatic lobular carcinoma of the breast
Histology: This neoplasm is composed of non-cohesive cells with a signet-ring appearance. A stain for mucin was positive, while immunolabeling for e-cadherin revealed a loss of e-cadherin expression. Immunolabeling for estrogen and progesterone receptors were both positive.
Discussion: Although the majority of neoplasms in the stomach are primary to the stomach, a metastasis should always be included in the differential. Metastatic breast cancer is particularly problematic for two reasons. First, as in this case, the history of breast cancer is often very remote. Breast cancers can metastasize 10 to 20 years after the primary was resected. Second, lobular carcinoma of the breast morphologically mimics diffuse (signet ring cell) gastric cancer. Two things help establish the diagnosis of metastatic breast cancer. The first is thinking of the diagnosis. Second, immunolabeling for breast markers including estrogen and progesterone receptors can help establish the organ of origin.
