Metastatic Occult Primary Lobular Breast Cancer: A Case Report

Breast cancer is the most common malignancy diagnosed in women. Invasive lobular breast cancer (ILC) is the second most common histologic subtype after invasive ductal carcinoma. Metastatic occult primary breast cancer, although rare, is a well-known clinical entity that usually presents with axilla...

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Published inCurēus (Palo Alto, CA) Vol. 16; no. 4; p. e58586
Main Authors Pouptsis, Athanasios, Cano Gimeno, Julia, Martinez Rubio, Carmen, Bañuls Marrades, Marta, Olivan Sasot, Patricia
Format Journal Article
LanguageEnglish
Published United States Cureus Inc 19.04.2024
Cureus
Subjects
Abdomen
Age
Antigens
Ascites
Biopsy
Breast cancer
Case reports
Colon
Colonoscopy
Cytokeratin
Estrogens
Gastroenterology
Hemoglobin
Lymphatic system
Mammography
Medical diagnosis
Metastasis
Oncology
Ovaries
Pelvis
Radiology
Thyroid gland
Tomography
Ultrasonic imaging
lobular
breast cancer
cdk 4/6 inhibitors
lobular breast cancer
metastatic
occult
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Abstract Breast cancer is the most common malignancy diagnosed in women. Invasive lobular breast cancer (ILC) is the second most common histologic subtype after invasive ductal carcinoma. Metastatic occult primary breast cancer, although rare, is a well-known clinical entity that usually presents with axillary lymphadenopathy without a detectable breast tumour. A perimenopausal woman in her 50s presented with abdominal pain, fatigue, and weight loss. Imaging showed peritoneal carcinomatosis with ascites, ovarian masses, and a lesion in the ascending colon. Gastric and colon biopsies showed infiltration from lobular breast cancer. Diagnostic workup, including mammography, breast ultrasound, and breast MRI, showed no evidence of breast pathology or axillary lymphadenopathy. First-line treatment with goserelin, letrozole, and palbociclib commenced with clinical improvement and radiological response. This case illustrates the challenges faced by clinicians in the diagnosis and treatment of lobular breast cancer without an identifiable primary lesion or axillary lymphadenopathy.
AbstractList Breast cancer is the most common malignancy diagnosed in women. Invasive lobular breast cancer (ILC) is the second most common histologic subtype after invasive ductal carcinoma. Metastatic occult primary breast cancer, although rare, is a well-known clinical entity that usually presents with axillary lymphadenopathy without a detectable breast tumour. A perimenopausal woman in her 50s presented with abdominal pain, fatigue, and weight loss. Imaging showed peritoneal carcinomatosis with ascites, ovarian masses, and a lesion in the ascending colon. Gastric and colon biopsies showed infiltration from lobular breast cancer. Diagnostic workup, including mammography, breast ultrasound, and breast MRI, showed no evidence of breast pathology or axillary lymphadenopathy. First-line treatment with goserelin, letrozole, and palbociclib commenced with clinical improvement and radiological response. This case illustrates the challenges faced by clinicians in the diagnosis and treatment of lobular breast cancer without an identifiable primary lesion or axillary lymphadenopathy.
Author Martinez Rubio, Carmen
Cano Gimeno, Julia
Pouptsis, Athanasios
Bañuls Marrades, Marta
Olivan Sasot, Patricia
AuthorAffiliation 1 Department of Medical Oncology, Hospital Universitario de la Ribera, Valencia, ESP
2 Department of Radiology, Hospital Universitario de la Ribera, Valencia, ESP
3 Department of Gastroenterology, Hospital Universitario de la Ribera, Valencia, ESP
4 Department of Nuclear Medicine, Hospital Universitario de la Ribera, Valencia, ESP
AuthorAffiliation_xml – name: 1 Department of Medical Oncology, Hospital Universitario de la Ribera, Valencia, ESP
– name: 4 Department of Nuclear Medicine, Hospital Universitario de la Ribera, Valencia, ESP
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– sequence: 2
  givenname: Julia
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Cites_doi 10.3233/BD-201027
10.2967/jnumed.120.247882
10.1001/jama.289.11.1421
10.1677/ERC-06-0060
10.1200/JCO.2015.64.0334
10.3390/healthcare11050746
10.1016/j.critrevonc.2014.07.003
10.1055/s-0043-109374
10.1186/s13058-015-0546-7
10.1016/j.ejso.2014.09.004
10.1155/2015/135684
10.1148/rg.291085100
10.1155/2018/4714708
10.7759/cureus.5367
10.1038/s41388-022-02314-w
10.1158/1538-7445.sabcs22-gs1-10
10.1016/S1470-2045(19)30804-6
10.1186/bcr3065
10.1016/j.ejca.2003.08.007
10.2147/BCTT.S366785
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Issue 4
Keywords lobular
breast cancer
cdk 4/6 inhibitors
lobular breast cancer
metastatic
occult
Language English
License Copyright © 2024, Pouptsis et al.
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References Lu Y-S (ref20) 2023; 83
Lopez JK (ref3) 2009; 29
Andrews JL (ref7) 2012; 14
Biglia N (ref2) 2007; 14
Dossus L (ref4) 2015; 17
Salemis NS (ref10) 2021; 40
Busbait S (ref12) 2022; 14
Mathew A (ref16) 2017; 77
Ogura K (ref13) 2015; 2015
Li CI (ref1) 2003; 289
Pereslucha AM (ref14) 2023; 11
Mantiero M (ref11) 2018; 2018
Gao JJ (ref18) 2020; 21
Beniey M (ref19) 2019; 11
Guiu S (ref15) 2014; 92
Desmedt C (ref8) 2016; 34
Ulaner GA (ref17) 2021; 62
Ferlicot S (ref9) 2004; 40
Sharma SD (ref5) 2015; 41
Rätze MA (ref6) 2022; 41
References_xml – volume: 40
  year: 2021
  ident: ref10
  article-title: Primary ectopic breast carcinoma in the axilla: a rare presentation and review of the literature
  publication-title: Breast Dis
  doi: 10.3233/BD-201027
  contributor:
    fullname: Salemis NS
– volume: 62
  year: 2021
  ident: ref17
  article-title: Head-to-head evaluation of (18)f-FES and (18)f-FDG PET/CT in metastatic invasive lobular breast cancer
  publication-title: J Nucl Med
  doi: 10.2967/jnumed.120.247882
  contributor:
    fullname: Ulaner GA
– volume: 289
  year: 2003
  ident: ref1
  article-title: Trends in incidence rates of invasive lobular and ductal breast carcinoma
  publication-title: JAMA
  doi: 10.1001/jama.289.11.1421
  contributor:
    fullname: Li CI
– volume: 14
  year: 2007
  ident: ref2
  article-title: Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: implications for diagnosis, surgical and medical treatment
  publication-title: Endocr Relat Cancer
  doi: 10.1677/ERC-06-0060
  contributor:
    fullname: Biglia N
– volume: 34
  year: 2016
  ident: ref8
  article-title: Genomic characterization of primary invasive lobular breast cancer
  publication-title: J Clin Oncol
  doi: 10.1200/JCO.2015.64.0334
  contributor:
    fullname: Desmedt C
– volume: 11
  year: 2023
  ident: ref14
  article-title: Invasive lobular carcinoma: A review of imaging modalities with special focus on pathology concordance
  publication-title: Healthcare (Basel)
  doi: 10.3390/healthcare11050746
  contributor:
    fullname: Pereslucha AM
– volume: 92
  year: 2014
  ident: ref15
  article-title: Invasive lobular breast cancer and its variants: how special are they for systemic therapy decisions?
  publication-title: Crit Rev Oncol Hematol
  doi: 10.1016/j.critrevonc.2014.07.003
  contributor:
    fullname: Guiu S
– volume: 77
  year: 2017
  ident: ref16
  article-title: Distinct pattern of metastases in patients with invasive lobular carcinoma of the breast
  publication-title: Geburtshilfe Frauenheilkd
  doi: 10.1055/s-0043-109374
  contributor:
    fullname: Mathew A
– volume: 17
  year: 2015
  ident: ref4
  article-title: Lobular breast cancer: incidence and genetic and non-genetic risk factors
  publication-title: Breast Cancer Res
  doi: 10.1186/s13058-015-0546-7
  contributor:
    fullname: Dossus L
– volume: 41
  year: 2015
  ident: ref5
  article-title: Surgical management of lobular carcinoma from a national screening program: a retrospective analysis
  publication-title: Eur J Surg Oncol
  doi: 10.1016/j.ejso.2014.09.004
  contributor:
    fullname: Sharma SD
– volume: 2015
  year: 2015
  ident: ref13
  article-title: Occult breast lobular carcinoma with numerous circulating tumor cells in peripheral blood
  publication-title: Case Rep Pathol
  doi: 10.1155/2015/135684
  contributor:
    fullname: Ogura K
– volume: 29
  year: 2009
  ident: ref3
  article-title: Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings
  publication-title: Radiographics
  doi: 10.1148/rg.291085100
  contributor:
    fullname: Lopez JK
– volume: 2018
  year: 2018
  ident: ref11
  article-title: Gastric linitis plastica and peritoneal carcinomatosis as first manifestations of occult breast carcinoma: a case report and literature review
  publication-title: Case Rep Oncol Med
  doi: 10.1155/2018/4714708
  contributor:
    fullname: Mantiero M
– volume: 11
  year: 2019
  ident: ref19
  article-title: Peritoneal metastases from breast cancer: a scoping review
  publication-title: Cureus
  doi: 10.7759/cureus.5367
  contributor:
    fullname: Beniey M
– volume: 41
  year: 2022
  ident: ref6
  article-title: Loss of E-cadherin leads to Id2-dependent inhibition of cell cycle progression in metastatic lobular breast cancer
  publication-title: Oncogene
  doi: 10.1038/s41388-022-02314-w
  contributor:
    fullname: Rätze MA
– volume: 83
  year: 2023
  ident: ref20
  article-title: Abstract GS1- 10: Primary results from the randomized phase II RIGHT Choice trial of premenopausal patients with aggressive HR+/HER2− advanced breast cancer treated with ribociclib + endocrine therapy vs physician’s choice combination chemotherapy
  publication-title: Cancer Res
  doi: 10.1158/1538-7445.sabcs22-gs1-10
  contributor:
    fullname: Lu Y-S
– volume: 21
  year: 2020
  ident: ref18
  article-title: CDK4/6 inhibitor treatment for patients with hormone receptor-positive, HER2-negative, advanced or metastatic breast cancer: a US Food and Drug Administration pooled analysis
  publication-title: Lancet Oncol
  doi: 10.1016/S1470-2045(19)30804-6
  contributor:
    fullname: Gao JJ
– volume: 14
  year: 2012
  ident: ref7
  article-title: The role and function of cadherins in the mammary gland
  publication-title: Breast Cancer Res
  doi: 10.1186/bcr3065
  contributor:
    fullname: Andrews JL
– volume: 40
  year: 2004
  ident: ref9
  article-title: Wide metastatic spreading in infiltrating lobular carcinoma of the breast
  publication-title: Eur J Cancer
  doi: 10.1016/j.ejca.2003.08.007
  contributor:
    fullname: Ferlicot S
– volume: 14
  year: 2022
  ident: ref12
  article-title: Occult invasive lobular carcinoma presenting as an axillary skin metastatic lesion underwent neoadjuvant endocrine therapy and surgical resection: a case report and review of literature
  publication-title: Breast Cancer (Dove Med Press)
  doi: 10.2147/BCTT.S366785
  contributor:
    fullname: Busbait S
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Snippet Breast cancer is the most common malignancy diagnosed in women. Invasive lobular breast cancer (ILC) is the second most common histologic subtype after...
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SubjectTerms Abdomen
Age
Antigens
Ascites
Biopsy
Breast cancer
Case reports
Colon
Colonoscopy
Cytokeratin
Estrogens
Gastroenterology
Hemoglobin
Lymphatic system
Mammography
Medical diagnosis
Metastasis
Oncology
Ovaries
Pelvis
Radiology
Thyroid gland
Tomography
Ultrasonic imaging
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Title Metastatic Occult Primary Lobular Breast Cancer: A Case Report
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