Upper gastrointestinal bleeding as a metastatic manifestation of breast cancer: A case report and review of the literature

CASE PRESENTATION: A 64-year-old woman with known metastatic lubular breast cancer presented with fever, epigastric pain, hematemesis and melena. A bl eeding, ulcerated gastric metastasis was found and was treated with endosco pic therapy, omeprazole and hormonal therapy. The patient was alive and wel l 13 months later. The bleeding was probably precipitated by necrosis of th e lesion during chemotherapy. DISCUSSION: Gastrointestinal tract metastases from primary breast carcinoma are present in 14% to 35% of cases in autopsy series, with gastric involve ment in 6% to 18% of cases. Recognized much less commonly during life than in autopsy studies, they can occur anywhere in the gut and can mimic virtua lly any gastrointestinal disorder. Endoscopy and barium studies facilitate diagnosis. Gastric lesions that have been noted include 'linitis plastica', nodules, polyps and ulcers. They are usually due to lobular breast carcino ma and resemble primary gastric carcinoma on microscopy. Reported cases of bleeding gastric metastases have been treated successfully with various loc al and systemic modalities. The median survival time of reviewed cases was four months from presentation (with a range of zero to 24 months). CONCLUSIONS: 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 treat ed successfully by endoscopic hemostatic therapy.