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Canadian Journal of Gastroenterology
Volume 15, Issue 1, Pages 67-71
Brief Communication

Upper Gastrointestinal Bleeding as a Metastatic Manifestation of Breast Cancer: A Case Report and Review of the Literature

Tony Reiman and Charles A Butts

Department of Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada

Received 21 September 1999; Accepted 13 October 1999

Copyright © 2001 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


CASE PRESENTATION: 64-year-old woman with known metastatic lobular breast cancer presented with fever, epigastric pain, hematemesis and melena. A bleeding, ulcerated gastric metastasis was found and was treated with endoscopic therapy, omeprazole and hormonal therapy; the patient was alive and well 13 months later. The bleeding was probably precipitated by necrosis of the lesion during chemotherapy.

DISCUSSION: Gastrointestinal tract metastases from primary breast carcinoma are present in 14% to 35% of cases in autopsy series, with gastric involvement in 6% to 18%. Recognized much less commonly during life than in autopsy studies, they can occur anywhere in the gut and can mimic virtually any gastrointestinal disorder. Endoscopy and barium studies facilitate diagnosis. Gastric lesions seen include 'linitis plastica', nodules, polyps and ulcers. They are usually due to lobular breast carcinoma and resemble primary gastric carcinoma on microscopy. Reported cases of bleeding gastric metastases have been treated successfully with various local and systemic modalities. The median survival time of reviewed cases was four months from presentation (range, 0 to 24 months).

CONCLUSION: Gastrointestinal metastasis is an underdiagnosed complication of breast cancer. Gastrointestinal bleeding from metastatic breast cancer is an uncommon presentation that is readily diagnosed and that can be treated successfully by endoscopic hemostatic therapy.