P0336 - A Rare Case of Colon Cancer With Hepatic Metastasis and Soft Tissue Metastasis to the Breast

Dharma Ayer, BS¹, Aryan Jain, BS, MBA¹, Rohit Dhingra, MD^2
1Albany Medical Center, Albany, NY; ²Albany Gastroenterology Consultants, Albany, NY

Introduction: Colorectal cancer (CRC) is a growing public health problem with a high incidence tied mostly to sporadic cases (70%). Metastasis of CRC is present in about 20% of patients at diagnosis with common locations being the liver and lungs. However, soft tissue metastases from CRC are a rare occurrence. We present a case of colonic adenocarcinoma with hepatic and soft tissue metastases of the breast. 

Case Description/Methods: A 78-year-old male presented to the clinic with a left breast lump for approximately 3 weeks. Mammogram reported a hypoechoic mass with ill-defined borders 7 cm distant from the nipple. Ultrasound guided biopsy and pathology reported that the mass had tumor cells positive for CDX20 and CK20, consistent with metastatic adenocarcinoma from the lower gastrointestinal tract. Upper endoscopy revealed a non-obstructing Schatzki ring, a hiatal hernia, erythematous mucosa in the antrum, and non-bleeding duodenal erosions. Colonoscopy revealed a large obstructing circumferential mass, involving two-thirds of the lumen, in the distal ascending colon and transverse colon. Colon mass biopsy displayed high grade dysplasia with no definite invasion. CT imaging displayed central and right mesenteric adenopathy. Additionally, hepatic hypodensities consistent with hepatic metastasis were present. The patient was diagnosed with stage IV colon cancer and is scheduled to begin chemotherapy.

Discussion: Late-stage CRC with distant metastases has poor survival beyond 5 years of diagnosis. Management often involves palliative treatment with the goal of delaying progression. In near obstructive colonic tumors, studies have shown that bevacizumab may increase risk of perforation and thus may not be a recommended treatment. First-line therapy such as the FOLFOX regimen is the preferred choice of management. Once PET scans are done for further clarification of findings, treatment may be optimized to limit toxicities and immune suppression. 



Disclosures:


Dharma Ayer, BS¹, Aryan Jain, BS, MBA¹, Rohit Dhingra, MD². P0336 - A Rare Case of Colon Cancer With Hepatic Metastasis and Soft Tissue Metastasis to the Breast, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.