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Volume 84 - 2021 - Fasc.2 - Letters

Duodenal metastasis of breast invasive carcinoma of no special type: a rare presentation

The authors read with attention the case report by Vande Berg and coworkers, published on a previous issue of this journal, describing a rare diagnosis of rectal metastases of an incognito invasive lobular breast carcinoma (ILC), for which immunohistochemistry was decisive (1). Likewise, we share a similarly rare case of gastrointestinal metastases of breast carcinoma (BC), in which immunohistochemistry played a pivotal role.A 55-year-old woman was diagnosed in June 2015 with an Invasive Breast Carcinoma of no-special-type (IBCNST) grade III, human epidermal growth factor receptor 2 (HER2) positive, estrogen and progesterone receptors (ER/PR) negative. Biopsy revealed vascular permeation. Neoadjuvant chemotherapy and trastuzumab preceded surgery, performed in December 2015, followed by radiotherapy and trastuzumab. The patient remained free of disease until 2017, when a right cerebellar lesion was diagnosed as BC metastasis and was treated with stereotactic radiosurgery. In January 2020, the patient presented with a 1-month history of post-prandial vomiting, epigastric pain, anorexia, fatigue, and a 10 kg weight loss. Lab tests were unremarkable, except for small increase in CA-125 and CA-15.3.


A cystic lesion mimicking pancreatic neoplasm

A 54-year old male patient was admitted with complaints of periodical pain in the upper abdomen, CA- 19.9-51 U/ml (reference range < 37 U/ml). Blood tests were normal. However, ultrasound scan results revealed growth of a pancreatic tumor over 52×38 mm. A CT scan was performed for further characterization of the lesion. A tumor mass of 54 mm in diameter of the pancreatic body was found. There was no differentiation of lesion border with pancreas body (Fig. 1). Surgical resection was performed without preoperative biopsy following the consensus of the International Study Group of Pancreatic Surgery which states that in the presence of a solid mass suspicious for malignancy, a biopsy proof is not required before proceeding with resection (1). A soft consistence pancreas cyst with pus-like content was resected during surgical operation....