P1809 - Obstructive Jaundice Secondary to Pancreatic Metastasis: A Rare Presentation of Breast Cancer

Mina Daniel, MD¹, Maria Kamel, MD², Roy Darshan, MD³, Christopher Herman, MD³, Muntasir Jahangir, MD³, Jigar Patel, MD^3
1Memorial Hermann Healthcare System, Cypress, TX; ²Columbus Central University, Cypress, TX; ³Memorial Hermann Healthcare System, The Woodlands, TX

Introduction: Metastasis of the pancreas from breast cancer is extremely uncommon. These patients may present with abdominal pain and obstructive jaundice, which can mimic primary or synchronous pancreas cancer. Distinguishing between metastatic breast and primary pancreatic adenocarcinoma relies on a histopathology exam. We present a case with index presentation of obstructive jaundice due to pancreas head mass secondary to metastatic breast cancer.

Case Description/Methods: A 53-year-old female presented with painless obstructive jaundice, decreased appetite, and significant weight loss. The pertinent labs on presentation were alkaline phosphatase 1437 unit/L, total bilirubin 13.5 mg/dL, and CA19-9 516 unit/ml. CT Abdomen/Pelvis with IV contrast showed marked biliary system dilatation due to distal common bile duct (CBD) obstruction, bilateral adrenal nodules, periportal lymph nodes, and diffuse sclerotic skeletal lesions consistent with metastases. Endoscopic ultrasound revealed a 23.9 x 17.2 mm heterogeneous mass in the head of the pancreas with significant parenchymal atrophy upstream of the mass. A fine needle biopsy of the mass was performed. Endoscopic retrograde cholangiopancreatography revealed a high-grade distal CBD stricture, which was managed with biliary stent placement. Histopathological examination of the pancreatic mass biopsy revealed breast adenocarcinoma. The oncology team recommended a bone marrow biopsy, which showed metastatic breast carcinoma that was estrogen receptor (ER)-positive, progesterone receptor (PR)-positive, and human epidermal growth factor receptor 2 (HER2)-negative. Due to her overall failure to thrive status, she was started on inpatient estrogen-blocking therapy, fulvestrant. A brain MRI for staging showed diffuse pachymeningeal enhancement and heterogeneous marrow signal in the clivus, indicative of metastasis. Due to rapid clinical deterioration and poor prognosis, the oncologist discussed palliative options with the patient and her family. The patient was transitioned to hospice care.

Discussion: Breast cancer with pancreatic involvement is uncommon (less than 3%) with an average of 43.3-month gap between the diagnosis of breast cancer and pancreatic metastasis. This case highlights the importance of histopathology examination of pancreas mass despite convincing presentation of primary pancreas adenocarcinoma. Unfortunately, our patient did not go through routine screening for breast cancer, which also highlights the importance of preventative cancer screening.



Disclosures:


Mina Daniel, MD¹, Maria Kamel, MD², Roy Darshan, MD³, Christopher Herman, MD³, Muntasir Jahangir, MD³, Jigar Patel, MD³. P1809 - Obstructive Jaundice Secondary to Pancreatic Metastasis: A Rare Presentation of Breast Cancer, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.