Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2023; 11(14): 3282-3287
Published online May 16, 2023. doi: 10.12998/wjcc.v11.i14.3282
Metastatic gastric cancer from breast carcinoma presenting with paraneoplastic rheumatic syndrome: A case report
Marília Bortoluz Rech, Eduarda Renz da-Cruz, Karina Salgado, Raul Angelo Balbinot, Silvana Sartori Balbinot, Jonathan Soldera
Marília Bortoluz Rech, Eduarda Renz da-Cruz, School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
Karina Salgado, Department of Pathology, ICAP Pathology, Caxias do Sul 95020-002, Rio Grande do Sul, Brazil
Raul Angelo Balbinot, Silvana Sartori Balbinot, Jonathan Soldera, Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
Author contributions: Rech MB, da-Cruz ER, Salgado K, Balbinot RA, Balbinot SS and Soldera J equally contributed to the writing and reviewing of the manuscript; Soldera J contributed as supervisor of the manuscript; All authors have read and approve the final manuscript.
Informed consent statement: The patient has verbally agreed to the reporting of the case.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Soldera, MD, MSc, Associate Professor, Staff Physician, Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Rua Francisco Getúlio Vargas, 1130, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil. jonathansoldera@gmail.com
Received: December 21, 2022
Peer-review started: December 21, 2022
First decision: January 20, 2023
Revised: February 2, 2023
Accepted: April 6, 2023
Article in press: April 6, 2023
Published online: May 16, 2023
Processing time: 145 Days and 18.5 Hours
Abstract
BACKGROUND

Breast cancer is the most frequently diagnosed cancer worldwide. It is the leading cause of death by malignant disease in women.

CASE SUMMARY

A female patient, 73 years of age, sought care due to weakness, mild abdominal pain, arthralgia, and weight loss. She was taking anastrazole as maintenance therapy for localized breast cancer and had moderate anemia and elevated acute-phase markers. Upper digestive endoscopy showed isolated erosion in the gastric corpus. This lesion was compatible with signet-ring cell adenocarcinoma in anatomopathological study and was confirmed as metastasis of a breast carcinoma in immunohistochemistry, which was positive for estrogen antibody. Further imaging studies determined numerous proximal bone metastases. The patient was treated with prednisone for paraneoplastic syndrome, which improved the anemia and rheumatic disease, and with chemotherapy, which greatly improved the symptoms. She has been followed-up for 6 mo, and her anemia, arthralgias, and acute phase markers have normalized.

CONCLUSION

Systemic treatment strategies seem to be the best choice for gastric metastasis from breast cancer, resulting in disease control and relapse-free survival. Prospective studies with longer follow-up are needed to better understand the biological, pathological, and clinicopathological characteristics and outcomes of the endoscopic features associated with metastatic gastric cancer from breast carcinoma.

Keywords: Breast cancer; Gastric metastasis; Anemia; Paraneoplastic syndrome; Case report

Core Tip: Breast cancer, the most frequently diagnosed type of cancer worldwide, is the leading cause of death due to malignant disease in women. We present the case of a female patient, 73 years of age, who sought care due to weakness, mild abdominal pain, arthralgia, and weight loss. She was taking anastrazole as a maintenance therapy for a localized breast cancer. She presented with moderate anemia and elevated acute phase markers. Upper digestive endoscopy showed isolated erosion in the gastric corpus. In anatomopathological study, the lesion was found to be compatible with signet-ring cell adenocarcinoma, while in in immunohistochemistry it was confirmed to be a metastasis of breast carcinoma, being positive for estrogen antibody. Further imaging studies determined numerous proximal bone metastases. The patient has been treated and followed up for 6 mo, and her anemia, arthralgias and acute phase markers have normalized. Systemic treatment strategies appear to be the best choice for gastric metastasis from breast cancer, providing disease control and relapse-free survival. Prospective studies with longer follow up are needed to better understand the biological, pathological, and clinicopathological characteristics and outcomes of the endoscopic features associated with metastatic gastric cancer from breast carcinoma.