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A rare case of malignant biliary stenosis due to retroperitoneal metastasis from breast invasive ductal carcinoma

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Abstract

A 50-year-old woman was referred to our hospital for elevated hepatobiliary enzymes. She had a medical history of mastectomy for left breast invasive ductal carcinoma about 10 years ago, and no apparent recurrence had been observed. Contrast-enhanced computed tomography (CT) revealed soft-tissue shadows surrounding the portal vein, celiac artery, and other vessels. The lesions involved the hilar bile duct, and the upstream bile ducts were dilated. Endoscopic retrograde cholangiography showed an obstruction in the hilar bile duct, and biopsies were taken at the site of biliary stenosis. H&E staining showed that cells with strong nuclear atypia and prominent chromatin staining infiltrated in the stroma. Immunohistochemical analysis revealed that the cells were positive for CK7, GATA3 and weakly positive for CK20. Based on these results, we made the diagnosis of biliary stenosis due to retroperitoneal metastasis from breast invasive ductal carcinoma. Biliary inside stents were placed across the biliary stricture, and she received chemotherapy plus endocrine therapy for breast cancer. So far, the partial response has been maintained for 1 year since the diagnosis of retroperitoneal metastasis. Although retroperitoneal metastasis from breast cancer, especially breast invasive ductal carcinoma, is extremely rare, it could be a differential diagnosis for biliary stenosis.

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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

H & E:

Hematoxylin and eosin

ERC:

Endoscopic retrograde cholangiography

EUS:

Endoscopic ultrasonography

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Kenta Mizukoshi, Akihisa Fukuda & Hiroshi Seno

  2. Department of Gastroenterology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinamba-cho, Amagasaki, Hyogo, 660-8550, Japan

    Misato Fujii & Yuki Yamauchi

Authors
  1. Kenta Mizukoshi
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  2. Misato Fujii
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  3. Yuki Yamauchi
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  4. Akihisa Fukuda
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  5. Hiroshi Seno
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Contributions

KM, MF, and YY participated in diagnosis and drafted this manuscript. AF and HS supervised this manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kenta Mizukoshi.

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Conflict of interest

Kenta Mizukoshi, Misato Fujii, Yuki Yamauchi, Akihisa Fukuda, and Hiroshi Seno declare that they have no conflicts of interest in this article.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Mizukoshi, K., Fujii, M., Yamauchi, Y. et al. A rare case of malignant biliary stenosis due to retroperitoneal metastasis from breast invasive ductal carcinoma. Clin J Gastroenterol 15, 199–204 (2022). https://doi.org/10.1007/s12328-021-01560-x

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  • DOI: https://doi.org/10.1007/s12328-021-01560-x

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