Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction
Intestinal lipomatosis is rare and often asymptomatic but can present with intestinal obstruction. Occasionally, metastatic breast cancer is identified in the ovary before a breast primary is discovered. We report the case of a 50-year-old woman diagnosed with synchronous intestinal obstruction due...
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| Format: | Article |
| Language: | English |
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University of São Paulo
2019-08-01
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| Series: | Autopsy and Case Reports |
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| Online Access: | http://www.revistas.usp.br/autopsy/article/view/161016 |
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| author | Isabel Armas Mariana Brandão Inês Guerreiro João Lobo Carla Freitas João Pinto-de-Sousa Joaquim Abreu de Sousa |
| author_facet | Isabel Armas Mariana Brandão Inês Guerreiro João Lobo Carla Freitas João Pinto-de-Sousa Joaquim Abreu de Sousa |
| author_sort | Isabel Armas |
| collection | DOAJ |
| description | Intestinal lipomatosis is rare and often asymptomatic but can present with intestinal obstruction. Occasionally, metastatic breast cancer is identified in the ovary before a breast primary is discovered. We report the case of a 50-year-old woman diagnosed with synchronous intestinal obstruction due to lipomatosis, and incidental ovarian metastases from breast cancer. The patient presented with a 12-day history of nausea, diffuse abdominal pain, and constipation. An abdominal x-ray showed air-fluid levels, and computed tomography documented small bowel distention. An explorative laparotomy was performed, which revealed small bowel distention, an obstructive lesion of the ileocecal valve, three terminal ileum lesions, ascites, and heterogeneous ovaries. Right ileocolic resection and left oophorectomy were performed. The pathological diagnosis revealed lipomatous submucosal lesion of the ileocecal valve and ileum, and 17 lymph nodes, which were all negative for malignant cells. The oophorectomy revealed ovarian metastasis from breast carcinoma. Ascitic fluid was positive for malignant cells. Mammography and breast/axillary ultrasonography showed a solid nodule of the left breast, ductal carcinoma, and multiple enlarged left axillary lymph nodes, which were positive for neoplastic cells. Immunohistochemical evaluation showed hormonal receptor positivity and C-erb2 negativity. Breast magnetic resonance imaging showed a 14 mm left nodule and a positron emission tomography scan revealed 18F-FDG uptake in the left breast, left axillary lymph nodes, right ovary, and peritoneum. The tumor was staged as stage IV ductal breast carcinoma, cT1N1M1, Grade 2, Luminal B-like. The multidisciplinary oncological meeting proposed chemotherapy, and a re-staging breast MRI after chemotherapy, which showed a complete response. The patient started treatment with letrozole and remains disease-free 22 months after finishing chemotherapy. |
| first_indexed | 2024-12-19T02:33:40Z |
| format | Article |
| id | doaj.art-d263163b0e1146d88b5908dcb14f8691 |
| institution | Directory Open Access Journal |
| issn | 2236-1960 |
| language | English |
| last_indexed | 2024-12-19T02:33:40Z |
| publishDate | 2019-08-01 |
| publisher | University of São Paulo |
| record_format | Article |
| series | Autopsy and Case Reports |
| spelling | doaj.art-d263163b0e1146d88b5908dcb14f86912022-12-21T20:39:32ZengUniversity of São PauloAutopsy and Case Reports2236-19602019-08-019110.4322/acr.2018.071Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstructionIsabel Armas0Mariana Brandão1Inês Guerreiro2João Lobo3Carla Freitas4João Pinto-de-Sousa5Joaquim Abreu de Sousa6Unidade Local de Saúde do Nordeste, General SurgeryInstituto Português de Oncologia do Porto, Medical OncologyInstituto Português de Oncologia do Porto, Medical OncologyInstituto Português de Oncologia do Porto, Patology DepartmentCentro Hospitalar Tâmega e Sousa, General SurgeryCentro Hospitalar Tâmega e Sousa, General SurgeryInstituto Português de Oncologia do Porto, Surgical OncologyIntestinal lipomatosis is rare and often asymptomatic but can present with intestinal obstruction. Occasionally, metastatic breast cancer is identified in the ovary before a breast primary is discovered. We report the case of a 50-year-old woman diagnosed with synchronous intestinal obstruction due to lipomatosis, and incidental ovarian metastases from breast cancer. The patient presented with a 12-day history of nausea, diffuse abdominal pain, and constipation. An abdominal x-ray showed air-fluid levels, and computed tomography documented small bowel distention. An explorative laparotomy was performed, which revealed small bowel distention, an obstructive lesion of the ileocecal valve, three terminal ileum lesions, ascites, and heterogeneous ovaries. Right ileocolic resection and left oophorectomy were performed. The pathological diagnosis revealed lipomatous submucosal lesion of the ileocecal valve and ileum, and 17 lymph nodes, which were all negative for malignant cells. The oophorectomy revealed ovarian metastasis from breast carcinoma. Ascitic fluid was positive for malignant cells. Mammography and breast/axillary ultrasonography showed a solid nodule of the left breast, ductal carcinoma, and multiple enlarged left axillary lymph nodes, which were positive for neoplastic cells. Immunohistochemical evaluation showed hormonal receptor positivity and C-erb2 negativity. Breast magnetic resonance imaging showed a 14 mm left nodule and a positron emission tomography scan revealed 18F-FDG uptake in the left breast, left axillary lymph nodes, right ovary, and peritoneum. The tumor was staged as stage IV ductal breast carcinoma, cT1N1M1, Grade 2, Luminal B-like. The multidisciplinary oncological meeting proposed chemotherapy, and a re-staging breast MRI after chemotherapy, which showed a complete response. The patient started treatment with letrozole and remains disease-free 22 months after finishing chemotherapy.http://www.revistas.usp.br/autopsy/article/view/161016LipomatosisIntestinal ObstructionBreast NeoplasmsNeoplasm MetastasisOvaryPeritoneum |
| spellingShingle | Isabel Armas Mariana Brandão Inês Guerreiro João Lobo Carla Freitas João Pinto-de-Sousa Joaquim Abreu de Sousa Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction Autopsy and Case Reports Lipomatosis Intestinal Obstruction Breast Neoplasms Neoplasm Metastasis Ovary Peritoneum |
| title | Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction |
| title_full | Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction |
| title_fullStr | Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction |
| title_full_unstemmed | Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction |
| title_short | Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction |
| title_sort | incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction |
| topic | Lipomatosis Intestinal Obstruction Breast Neoplasms Neoplasm Metastasis Ovary Peritoneum |
| url | http://www.revistas.usp.br/autopsy/article/view/161016 |
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