Neena Malik, MD, MS1, Lawrence Brandt, MD, MACG2, Ali Kazerouni Timsar, MD2
1Albert Einstein College of Medicine, Bronx, NY; 2Montefiore Medical Center, Bronx, NY
Introduction: The following case highlights a rare site for breast cancer metastasis, as well as demonstrates the importance of careful attention to all structures including the oral cavity, during endoscopy.
Case Description/Methods: A 53-year-old woman with a history of a recent dental abscess presented with weakness. She reported that 2 weeks before presentation she developed a dental abscess that required drainage. Upon further questioning, she also recalled a 2-month history of right breast pain and swelling. CT abdomen and pelvis obtained raised concern for infiltrative breast cancer with metastases to the liver, lung, bone, and brain. Prior to dedicated breast imaging and biopsy, the patient developed large-volume hematemesis and urgent endoscopy was performed. As the endoscope was advanced into the mouth, a 15 mm soft, friable polypoid mass was seen on the hard palate off the midline, as well as a cratered lesion with rounded walls in the gastric body. These lesions were biopsied with pathology showing poorly differentiated carcinoma composed of nests of malignant cells with marked atypia and pleomorphism, positive for pancytokeratin, GATA3 and CK7. The morphology and immunoprofile supported the diagnosis of metastatic carcinoma of breast origin.
Discussion: Breast cancer most often metastasizes to the liver, lung, bone, and brain. Gastric metastases are infrequent, with an estimated incidence rate of approximately 0.3%. Metastasis of malignant tumors to the oral cavity is exceedingly rare and accounts for approximately 1% of all malignant oral tumors. There are insufficient data to account for the true incidence for breast cancer metastasis to the oral cavity. Management of metastatic breast carcinomas of the oral cavity is primarily palliative, as prognosis for patients with these metastatic lesions is generally poor. As gastroenterologists, we are often focused solely on the proximal gastrointestinal tract during upper endoscopy, but we have the ability to fully evaluate and detect abnormalities of a number of other structures, including the oral cavity, oropharynx, and larynx. We should take full advantage of this opportunity to view these structures in an attempt to aid in early detection of what would otherwise be neglected disease. This case not only demonstrates the need for awareness of the oral cavity as a potential site for metastasis of breast cancer and its associated poor prognosis, but it also highlights the key principle of conducting a thorough endoscopic evaluation.
Citation: Neena Malik, MD, MS; Lawrence Brandt, MD, MACG; Ali Kazerouni Timsar, MD. P0381 - THE MOUTH IS MORE THAN JUST AN ENTRY PATH TO THE ESOPHAGUS: A RARE SITE OF BREAST CANCER METASTASIS. Program No. P0381. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.