P1673 - A Rare Case of Recurrent Gastric Outlet Obstruction as an Initial Presentation of Metastatic Inactive Lobular Breast Carcinoma

Murad Qirem, MD¹, Raed Atiyat, MD¹, Samer Jumean, MD², Shahd Yaghi, MD¹, Byron Okwesili, MD¹, Yatinder Bains, MD¹, Mehul Shah, MD^1
1New York Medical College - Saint Michael's Medical Center, Newark, NJ; ²Saint Michaels Medical Center, Newark, NJ

Introduction: Breast cancer ranks as the second most frequently diagnosed cancer in women, constituting over 10% of new cancer cases annually. Invasive Lobular Carcinoma (ILC), comprising 5% to 15% of breast cancer cases, exhibits a notable tendency for distant metastasis, typically affecting the bone, lung, pleura, soft tissue, and liver. However, metastasis to the GI tract is relatively uncommon.

In the case below, we report a rare occurrence of gastric metastasis from a patient previously in remission of ILC. This presentation is even more rare than the previously reported cases, as their reported cases involved active ILC.

Case Description/Methods: This is of a 66-year-old woman with history of ILC in her left breast. She underwent a left-sided mastectomy eight years ago, and subsequent follow-up scans showed no signs of recurrence.

She presented to our clinic, expressing concerns of early satiety, along with nausea and vomiting that have persisted for six months. She described the vomit as primarily food content. Additionally, she reported a weight loss of 50 pounds during this period.

An initial EGD was done, revealing gastric stenosis at the pylorus but no visible lesions or ulcers. A biopsy indicated gastritis only. Balloon dilatation was attempted 3 times 2 weeks apart each. However, the patient’s symptoms persisted. Subsequently, the patient underwent surgical evaluation and opted for an antrectomy, during which an extrinsic mass was discovered at the pylorus. A partial gastrectomy was carried out, along with a Roux-en-Y gastrojejunostomy procedure.

The resected tissue was sent for pathology and immunohistochemical staining. The results indicated lobular breast carcinoma, showing positivity for CK7, GATA3, Pan-cytokeratin, mammoglobin, as well as estrogen and progesterone receptors. She was referred for further evaluation and treatment with oncology.

Discussion: To the best of our knowledge, this is the first case of ILC relapsing as gastric metastasis after being in remission. We recommend maintaining a high index of suspicion in patients with a prior history of breast cancer, particularly ILC if they exhibit GI symptoms, even if these symptoms are mild or subtle. It is crucial to consider malignancy at stenotic segments when performing endoscopy and possibly obtain a deep biopsy with a comprehensive immunostaining panel. This approach is essential as metastatic lesions can closely resemble primary gastric cancer in histological examinations, warranting a careful and thorough diagnostic evaluation.



Disclosures:


Murad Qirem, MD¹, Raed Atiyat, MD¹, Samer Jumean, MD², Shahd Yaghi, MD¹, Byron Okwesili, MD¹, Yatinder Bains, MD¹, Mehul Shah, MD¹. P1673 - A Rare Case of Recurrent Gastric Outlet Obstruction as an Initial Presentation of Metastatic Inactive Lobular Breast Carcinoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.