An unusual presentation of breast cancer metastasis to the stomach
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Anotācija
Krūts vēzis ir visbiežāk sastopamā onkoloģiskā saslimšana sieviešu vidū gan pasaulē, gan arī Latvijā. Katru gadu Latvijā tiek atklāti vairāk kā 1000 jauni krūts vēža saslimšanas gadījumi.
Pateicoties skrīninga programmām, krūts vēzi ir iespējams diagnosticēt tā agrīnās attīstības stadijās, taču daudzas sievietes šo iespēju neizmanto, līdz ar ko krūts vēzis tiek atklāts vēlīnās stadijās, kas ievērojami samazina dzīvildzi un prognozi.
Krūts vēzis visbiežāk izplatās uz kauliem, plaušām, aknām un smadzenēm, taču salīdzinoši retāk tas var izplatīties arī uz gastrointestinālo traktu. Metastāzes kuņģī var būt sarežģīti diagnosticēt un atšķirt no primāra audzēja, sakarā ar to morfoloģiskajām pazīmēm, kas atgādina primāru kuņģa vēzi. Ir ļoti svarīgi diferencēt primāru kuņģa vēzi no krūts vēža metastāzēm kuņģī, jo rekomendētā terapija šajos gadījumos būtiski atšķiras.
Klīniskā gadījuma prezentācijas ietvaros tika analizēts un izvērtēts klīniskais gadījums Paula Stradiņa Klīniskās Universitātes slimnīcā par 75 gadus vecu sievieti, kura vērsās pēc palīdzības pie primārās aprūpes speciālista sakarā ar sāpēm un diskomfortu vēdera apvidū. Sieviete tika nosūtīta pie gastroenterologa, kurš pacientei veica fibrogastroduodenoskopiju (FGD), kas atklāja veidojumu kuņģī, no kura tika veikta biopsija, kas uzrādīja difūzu infiltrāciju ar gredzenveida šūnu kompleksiem kuņģa gļotādā. Imūnhistoķīmiskā analīze uzrādīja, ka veidojums ir citokeratīna 7 (CK 7), progesterona (PR) un estrogēna receptoru (ER) pozitīvs.
Balstoties uz atradnēm, tika uzstādīta primārā diagnoze- primāra gredzenveida kuņģa karcinoma, taču patalogs norādīja uz iespējamu veidojuma izcelsmi no krūts audiem, jo kā daudzos literatūras avotos tiek minēts, krūts vēža metastāzes kuņģī, pēc morfoloģiskajiem parametriem, spēj imitēt gredzenveida kuņģa karcinomas ainu, kā arī paciente nebija veikusi krūts vēža skrīninga izmeklējumus.
Paciente tika nosūtīta tālākai izmeklēšanai uz Paula Stradiņa Klīniskās Universitātes slimnīcas krūts centru, kur pēc mammogrāfijas un core biopsijas, ultrasonogrāfijas kontrolē,iegūtajiem rezultātiem, diagnoze tika mainīta uz labās krūts infiltratīvu lobulāru karcinomu ar metastāzēm kuņģī.
Šī klīniskā gadījuma analīze parādīja, cik liela loma krūts vēža diagnostikā ir skrīningizmeklējumiem un imūnhistoķīmiskai paraugu analīzei, kas var atklāt slimību agrīnā tās attīstības stadijā un norādīt uz primārā audzēja izcelsmi un lokalizāciju. Ņemot vērā morfoloģiskās sakarības starp primāru gredzenveida kuņģa karcinomu un krūts vēža metastāzēm kuņģī, būtu rūpīgāk jāizmeklē sievietes krūts vēža attīstības riska grupā ar sūdzībām no gastrointestinālā trakta.
Anotation Breast cancer is the most common oncological disorder between women in world and also in Latvia. Each year in Latvia there are more than 1000 new cases of breast cancer diagnosed. With breast cancer screening programs it is possible to diagnose breast cancer in its early stages, but,unfortunatelly, many women chooses not to perform them, which results with worse survival rate and overall prognosis. Breast cancer most often metastasizes to the bones, lungs, liver and brain, but it rarely metastasizes to the gastrointestinal tract. Metastasis to the stomach can be difficult to diagnose due to its morphological resemblance to primary gastric cancer. It is crucial to differentiate primary site of the disease as the treatment options and overall prognosis are different. In this case report i report a case about 75-year-old female presented to Pauls Stradins Clinical University Hospital, Riga, Latvia, with complaint of epigastric pain and discomfort. The patient was referred to gastroenterology by her primary care physician and had esophagogastroduodenoscopy (EGD) performed. The EGD revealed pathological mass in the gastric mucosa. The biopsy was performed, which revealed diffuse infiltration of signet ring cell carcinoma complexes in gastric mucosa. The samples were cytokeratin 7 (CK 7), progesterone receptor (PR) and estrogen receptor (ER) positive. On the basis of these findings, the diagnosis was thought to be a signet ring cell gastric carcinoma, but pathologist draw attention to possible origin from breast tissue, as mentioned in recent studies that breast cancer metastasis in the stomach can mimic primary signet ring cell gastric cancer, and patient, as well, have not been to the breast cancer screening mammography examination. The patient was referred on further breast examination, which discovered poorly differentiated infiltrative lobular breast carcinoma. The diagnosis was revised to primary breast cancer with gastric metastasis. This case report showed how important are breast cancer screening examinations to diagnose breast cancer in its early stages when it is localised. This report also showed how important role is for immunohystochemistry to diagnose primary site of the disease. Based on the morphological resemblance between primary gastric signet ring cell carcinoma and breast cancer metastasis to the stomach, it is important to give more attention to the women with complaint of gastrointestinal symptoms in the risk age group of breast cancer.
Anotation Breast cancer is the most common oncological disorder between women in world and also in Latvia. Each year in Latvia there are more than 1000 new cases of breast cancer diagnosed. With breast cancer screening programs it is possible to diagnose breast cancer in its early stages, but,unfortunatelly, many women chooses not to perform them, which results with worse survival rate and overall prognosis. Breast cancer most often metastasizes to the bones, lungs, liver and brain, but it rarely metastasizes to the gastrointestinal tract. Metastasis to the stomach can be difficult to diagnose due to its morphological resemblance to primary gastric cancer. It is crucial to differentiate primary site of the disease as the treatment options and overall prognosis are different. In this case report i report a case about 75-year-old female presented to Pauls Stradins Clinical University Hospital, Riga, Latvia, with complaint of epigastric pain and discomfort. The patient was referred to gastroenterology by her primary care physician and had esophagogastroduodenoscopy (EGD) performed. The EGD revealed pathological mass in the gastric mucosa. The biopsy was performed, which revealed diffuse infiltration of signet ring cell carcinoma complexes in gastric mucosa. The samples were cytokeratin 7 (CK 7), progesterone receptor (PR) and estrogen receptor (ER) positive. On the basis of these findings, the diagnosis was thought to be a signet ring cell gastric carcinoma, but pathologist draw attention to possible origin from breast tissue, as mentioned in recent studies that breast cancer metastasis in the stomach can mimic primary signet ring cell gastric cancer, and patient, as well, have not been to the breast cancer screening mammography examination. The patient was referred on further breast examination, which discovered poorly differentiated infiltrative lobular breast carcinoma. The diagnosis was revised to primary breast cancer with gastric metastasis. This case report showed how important are breast cancer screening examinations to diagnose breast cancer in its early stages when it is localised. This report also showed how important role is for immunohystochemistry to diagnose primary site of the disease. Based on the morphological resemblance between primary gastric signet ring cell carcinoma and breast cancer metastasis to the stomach, it is important to give more attention to the women with complaint of gastrointestinal symptoms in the risk age group of breast cancer.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Metastātisks krūts vēzis, gredzenveida šūnu kuņģa karcinoma, imūnhistoķīmija, Metastatic breast cancer, signet ring cell gastric carcinoma, immunohystochemistry