Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2021; 13(2): 147-156
Published online Feb 15, 2021. doi: 10.4251/wjgo.v13.i2.147
Rare common bile duct metastasis of breast cancer: A case report and literature review
Jie Tang, Guang-Xi Zhao, Shuang-Shuang Deng, Ming Xu
Jie Tang, Guang-Xi Zhao, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
Shuang-Shuang Deng, Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
Ming Xu, Department of Gastroenterology, Pudong New Area People's Hospital, Shanghai University of Medicine & Health Sciences, Shanghai 201200, China
Author contributions: Tang J and Zhao GX reviewed the patient information and wrote the manuscript; Deng SS reviewed the pathologic findings and wrote the manuscript; Xu M designed, reviewed, and wrote the manuscript; All authors have read and approved the final manuscript.
Supported by Top-level Clinical Discipline Project of Shanghai Pudong, No. PWYgf2018-04.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming Xu, MD, Chief Physician, Department of Gastroenterology, Pudong New Area People's Hospital, Shanghai University of Medicine & Health Sciences, No. 490 Chuanhuan South Road, Pudong New Area, Shanghai 201200, China. xm73dr@163.com
Received: November 6, 2020
Peer-review started: November 6, 2020
First decision: November 30, 2020
Revised: December 11, 2020
Accepted: December 26, 2020
Article in press: December 26, 2020
Published online: February 15, 2021
Abstract
BACKGROUND

Breast cancer is the most common tumor in women, and about one-third of cases develop metastatic disease. However, metastatic breast cancer rarely invades the common bile duct (CBD) directly without involving the liver, and involvement of the gastrointestinal tract is rare. Cases of such metastases pose a particular diagnostic challenge.

CASE SUMMARY

A 55-year-old female presented to the Department of Gastroenterology with complaint of a 2 mo history of right upper abdominal pain accompanied by pain in the right back, aggravated after eating greasy diet. The patient had received a diagnosis of breast cancer 3 years prior. Physical examination showed obvious superficial protuberant erythema on the left neck and chest skin, with slight tenderness and burning sensation. Endoscopic retrograde cholangiopancre-atography showed an obstruction at the end of the CBD. Histopathology of the CBD and symptomatic skin biopsies showed positivity for cytokeratin 7 and trans-acting T-cell-specific transcription factor breast cancer biomarkers. A cancer embolus was also found in the skin vasculature. Accordingly, the diagnosis of breast cancer metastases to the skin and biliary ducts was made. A plastic biliary sent was placed, which relieved the right upper abdominal pain and protected against unnecessary hepatectomy surgery.

CONCLUSION

Although rare, biliary metastasis should be considered in patients with bile duct stenosis and a history of breast cancer.

Keywords: Breast cancer, Common bile duct, Metastases, Plastic stent, Prognosis, Case report

Core Tip: Breast cancer is the most common tumor in women, and about one-third of cases develop metastatic disease. However, metastatic breast cancer rarely invades the common bile duct (CBD) directly without involving the liver, and involvement of the gastrointestinal tract is rare. We report a case of CBD metastasis from breast cancer that was diagnosed according to findings from endoscopic retrograde cholangiopancre-atography imaging and histopathology of CBD and symptomatic skin biopsies. This case highlights the importance of making an accurate diagnosis before undertaking an operative approach. Although CBD metastasis of breast cancer is rare, it should not be completely ignored.