Gastric Outlet Obstruction in a Breast Cancer Survivor: Evaluation and Treatment

Breast cancer patients need to be on regular follow-up after definitive treatment, for early detection and treatment of recurrence or distant metastasis. Gastrointestinal and peritoneal metastases from breast cancer are rare. Invasive lobular carcinoma has a tendency to spread to the gastrointestinal organs, and usually, is present a few years after the primary breast cancer has been treated. Histopathological examination with immunohistochemistry (IHC) analysis is paramount for diagnosis. We report a 49-year-old lady, treated for carcinoma breast 7 years back, on regular follow-up, who presented with features of gastric outlet obstruction. Endoscopic biopsy and detailed IHC from stomach was suggestive of metastases from breast carcinoma. Initial diagnostic and staging workup failed to detect peritoneal metastasis, however, which was confirmed by final histopathology from peritoneal biopsy. A high index of suspicion and accurate tissue diagnosis is imperative to plan the treatment in patients with a history of breast cancer with coexisting gastric symptoms. If a patient with solitary gastric metastasis is planned for curative surgical resection, it is very important to perform a staging laparoscopy and peritoneal biopsy to rule out metastasis to avoid unnecessary morbidity.