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Year : 2020  |  Volume : 35  |  Issue : 1  |  Page : 82-83  

Unusual gastric metastasis in triple-negative (estrogen receptor/progesterone receptor/HER2neu negative) GATA-binding protein 3-positive breast cancer


1 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

Date of Submission29-Aug-2019
Date of Acceptance18-Sep-2019
Date of Web Publication31-Dec-2019

Correspondence Address:
Dr. Atul Batra
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_156_19

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   Abstract 


Triple-negative breast cancer (TNBC) accounts for 20%–25% of breast cancer cases. Around 10%–15% of patients with breast cancer present with upfront metastasis. Lymph node, bone, and liver are common sites of metastasis in hormone-positive breast cancer while brain, lungs, and liver in TNBC. Although visceral metastasis is common in TNBC, metastasis to stomach is unusual. Morphological similarity of primary gastric carcinoma and lobular invasive breast carcinoma often leads to misdiagnosis. Meticulous review of histopathology and immunohistochemistry is essential for diagnosis. We present a case of carcinoma breast with unusual gastric nodular metastasis detected on18F-fluorodeoxyglucose positron emission tomography–computed tomography.

Keywords: 18F-Fluorodeoxyglucose positron emission tomography–computed tomography, gastric metastases, GATA-binding protein 3, triple-negative breast cancer


How to cite this article:
Baa AK, Naik RD, Vanidassane I, Arora S, Shamim SA, Mallick S, Batra A. Unusual gastric metastasis in triple-negative (estrogen receptor/progesterone receptor/HER2neu negative) GATA-binding protein 3-positive breast cancer. Indian J Nucl Med 2020;35:82-3

How to cite this URL:
Baa AK, Naik RD, Vanidassane I, Arora S, Shamim SA, Mallick S, Batra A. Unusual gastric metastasis in triple-negative (estrogen receptor/progesterone receptor/HER2neu negative) GATA-binding protein 3-positive breast cancer. Indian J Nucl Med [serial online] 2020 [cited 2020 Sep 26];35:82-3. Available from: http://www.ijnm.in/text.asp?2020/35/1/82/274364



A 47-year-old woman presented with complaints of a lump in her left breast for 8 months and dyspepsia for 1month. Trucut biopsy from the left breast lump showed invasive ductal carcinoma (IDC). Immunohistochemistry(IHC) showed negative estrogen receptor(ER, Allred score 0/8), progesterone receptor (PR, Allred score 0/8), and Her2neu staining, but immunopositive for GATA-binding protein 3(GATA 3).18 F-fluorodeoxyglucose positron emission tomography–computed tomography (18 F-FDG PET/CT) [Figure 1] was planned for staging. The maximum intensity projection image [Figure 1]a and axial sections of fused PET/CT [Figure 1]b and [Figure 1]c revealed a mass in the left breast involving overlying skin and infiltrating underlying pectoral muscle with increased FDG uptake (maximum standardized uptake value [SUVmax] 15.5)[Figure 1]a and [Figure 1]b, red arrow], along with multiple skeletal metastases [Figure 1]a, black arrows]. There is another nodular lesion with increased FDG uptake (SUVmax8.3) involving body of proximal stomach [Figure 1]a, curved arrow and [Figure 1]c, white arrow]. Upper gastrointestinal (GI) endoscopy showed submucosal lesion along the greater curvature of stomach [Figure 1]d, black arrow]. Biopsy from the gastric nodule showed fibrocollagenous tissue infiltrated by atypical cells [Figure 1]e, black arrow]. The cells were immunopositive for GATA 3 [Figure 1]f, black arrow] and ER, focal positive for gross cystic disease fluid protein 15 (GCDFP-15) [Figure 1]g, black arrow], while negative for PR and HER2neu, which helped in establishing the metastatic nature of gastric nodule (from breast primary) rather than primary gastric malignancy.
Figure 1: The maximum intensity projection image (a) and axial sections of positron emission tomography–computed tomography (b and c) revealed mass in the left breast with increased fluorodeoxyglucose uptake (maximum standard uptake value 15.5) (a and b, red arrow) with multiple skeletal metastases (a, black arrows). There is fluorodeoxyglucose avid nodular lesion (maximum standard uptake value 8.3) involving body of proximal stomach (a, curved arrow; and c white arrow). Upper gastrointestinal endoscopy showed submucosal lesion along the greater curvature of stomach (d, black arrow). Biopsy from the gastric nodule showed atypical cells (e, black arrow), which are immunopositive for GATA-binding protein 3 (f, black arrow) and focal positive for gross cystic disease fluid protein 15 (1g, black arrow)

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Triple-negative breast cancer (TNBC) accounts for 20%–25% of breast cancer cases. Lymph node, bone, and liver are common sites of metastasis in hormone receptor-positive breast cancer while lung, brain, and liver are common in TNBC.[1] Visceral metastasis is common in TNBC; however, metastasis to stomach is uncommon. Further, there is considerable difference in pattern of metastatic spread between invasive lobular carcinoma (ILC) and IDC, with common sites of metastases reported with IDC being bone, lungs, and liver. On the contrary, ILC has greater propensity for metastasis to GI tract, peritoneum, and pelvic organs.[2],[3],[4] Isolated gastric metastases are rare; they usually have multiple other sites of metastasis. A study done by Xu et al. has shown that breast cancer patients with gastric metastasis have simultaneous bone, liver, and lungs metastases in 50%, 20.4%, and 12.2%, respectively.[5] Linitis plastica (diffuse infiltration of muscle layer) is the most common subtype associated with gastric metastasis, while submucosal nodular variant is relatively uncommon. Morphological similarity of signet ring gastric carcinoma and invasive lobular breast carcinoma also complicates diagnosis and needs further immunostaining to avoid misdiagnosis. Primary gastric cancer can also show positivity for ER and ER in 32% and 12%, respectively, hence that is inadequate for confirming a definite metastasis from breast cancer.[6] GATA 3 is part of GATA family of zinc-finger binding transcription factors which are involved in the differentiation of many cell types.[7] It is expressed in many tissues at low level which is usually not detectable by IHC, and it has been shown as a specific IHC marker for breast and urothelial carcinomas.[8] Regarding breast cancer, it is of most significance in TNBC, where proving origin from the breast is difficult by IHC (ER−/PR−/Her2−). Positive cytoplasmic staining for GCDFP-15 has also been found to be a sensitive (55%–76%) and specific (95%–100%) marker to establish mammary origin and correctly identify lesion to be metastatic from breast primary.[9] Our patient has completed three cycles of chemotherapy (paclitaxel 175 mg/m2 every 3 weeks) until now, and she is under regular follow-up.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Foulkes WD, Smith IE, Reis-Filho JS. Triple-negative breast cancer. N Engl J Med 2010;363:1938-48.  Back to cited text no. 1
    
2.
McLemore EC, Pockaj BA, Reynolds C, Gray RJ, Hernandez JL, Grant CS, et al. Breast cancer: Presentation and intervention in women with gastrointestinal metastasis and carcinomatosis. Ann Surg Oncol 2005;12:886-94.  Back to cited text no. 2
    
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Borst MJ, Ingold JA. Metastatic patterns of invasive lobular versus invasive ductal carcinoma of the breast. Surgery 1993;114:637-41.  Back to cited text no. 3
    
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Taal BG, Peterse H, Boot H. Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma. Cancer 2000;89:2214-21.  Back to cited text no. 4
    
5.
Xu L, Liang S, Yan N, Zhang L, Gu H, Fei X, et al. Metastatic gastric cancer from breast carcinoma: A report of 78 cases. Oncol Lett 2017;14:4069-77.  Back to cited text no. 5
    
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Jones GE, Strauss DC, Forshaw MJ, Deere H, Mahedeva U, Mason RC. Breast cancer metastasis to the stomach may mimic primary gastric cancer: Report of two cases and review of literature. World J Surg Oncol 2007;5:75.  Back to cited text no. 6
    
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Zheng R, Blobel GA. GATA transcription factors and cancer. Genes Cancer 2010;1:1178-88.  Back to cited text no. 7
    
8.
Liu H, Shi J, Wilkerson ML, Lin F. Immunohistochemical evaluation of GATA3 expression in tumors and normal tissues: A useful immunomarker for breast and urothelial carcinomas. Am J Clin Pathol 2012;138:57-64.  Back to cited text no. 8
    
9.
Honma N, Takubo K, Arai T, Younes M, Kasumi F, Akiyama F, et al. Comparative study of monoclonal antibody B72.3 and gross cystic disease fluid protein-15 as markers of apocrine carcinoma of the breast. APMIS 2006;114:712-9.  Back to cited text no. 9
    


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