Small bowel obstruction due to metastatic breast cancer

Abstract

Background

Breast cancer represents 8% of secondary metastatic malignancies of the gastrointestinal tract. Invasive lobular carcinoma (ILC) is the second most common histological type of invasive breast cancer and is significantly more likely to metastasize to the gastrointestinal (GI) tract than invasive ductal carcinoma (IDC). The increased survival of patients suffering from breast cancer is leading physicians to face more often unusual causes of small bowel obstruction due to metastatic disease.

Methods

A 69-year-old female patient presented to our emergency department with a history of left breast quadrantectomy and left axillary dissection performed sixteen years earlier for grade III invasive ductal carcinoma (IDC) and left mastectomy three years earlier due to local recurrence (grade III IDC), followed a year later by a right modified radical mastectomy for grade III invasive lobular carcinoma (ILC). The patient had undergone hormonal therapy and radiotherapy and was considered to be disease-free. She presented with typical signs and symptoms of small bowel obstruction and underwent diagnostic laparotomy.

Results

The laparotomy revealed a jejunal tumour and enlarged mesenteric lymph nodes. The patient underwent partial small bowel resection with latero-lateral jejunoduodenal anastomosis. A biopsy revealed metastatic disease of the known ILC. The patient was referred to the oncologists and began systemic treatment.

Conclusion

Metastatic ILC should remain high on the differential diagnosis in female patients presenting with GI tract malignancies of unknown origin.