Small bowel obstruction from gastrointestinal involvement of a previously undiagnosed metastatic lobular breast cancer: a case report

Joan Tefay; Prathyusha Nakka

doi:10.5455/IJMRCR.Smallbowelobstructionfromgastrointestinalinvolvementofapreviouslyundiagnosedmetastat

Abstract
Breast cancer is the most common cancer affecting women. Prognostic factors include size, grade and hormone receptor status of the primary disease, regional node involvement and distant metastatic disease. Lobular breast cancer is the second most common type of breast cancer with a tendency for unusual metastatic distribution including gastrointestinal (GI) tract involvement. However, GI tract metastasis remains rare and clinical presentation can be vague and misleading.

We describe a 67-year-old Caucasian female with no known history of breast cancer who presented with acute small bowel obstruction on a background of long-standing nonspecific abdominal symptoms that led to the diagnosis of metastatic lobular breast cancer. Patient had an emergent diagnostic laparoscopy demonstrating a stricture in the distal ileum, which was subsequently resected. Histopathological examination confirmed a diagnosis of metastatic lobular breast carcinoma and subsequent work up found a breast primary, regional lymph node involvement and widespread bony metastases.

Although GI tract manifestation of distant metastases of lobular breast carcinoma is rare, it is a recognised entity. Given the high prevalence of breast cancer in elderly women and the propensity for unusual distant metastatic involvement of invasive lobular breast carcinoma, it is prudent for treating clinicians to maintain a reasonable index of suspicion whilst investigating elderly women with vague abdominal symptoms, especially those who do not routinely undergo breast cancer screening.

Key words: metastatic lobular breast cancer, small bowel obstruction, gastrointestinal tract involvement in metastatic breast cancer, invasive lobular breast carcinoma

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