Gastric Metastasis Mimicking Linitis Plastica 20 Years after Primary Breast Cancer. A Case Report

Breast cancer metastases to the gastrointestinal tract are rare, with a median time interval from the diagnosis of the primary tumor to metastasis up to 7 years. The stomach is the most frequent metastatic site and invasive lobular carcinoma is the type with the highest affinity to the digestive system. We report the case of an 84-year-old female patient, with a past medical history 20 years earlier of invasive lobular carcinoma of the breast, who presented for dyspepsia. Upper endoscopy revealed hypertrophic gastric folds compatible with primary linitis plastica. Histology showed proliferation of malignant poorly cohesive cells. Immunohistochemistry stain showed intense positivity of estrogen receptors and anti-GATA-binding protein 3 nuclear antibodies, and absence of the human epidermal growth factor receptor 2. These findings confirmed the diagnosis of a metachronous metastasis of the invasive lobular breast adenocarcinoma. Considering metastases from breast cancer is crucial when patients with any subtle gastric symptom and a past medical history of invasive lobular adenocarcinoma of the breast seek medical advice, even though more than 20 years after primary breast cancer. Immunohistochemistry is the key to final diagnosis as these lesions can endoscopically and histologically mimic primary linitis plastica.