Gastric and Endobronchial Metastases in a Case of Lobular Breast Cancer
A 51-year-old female patient underwent quadrantectomy with right axillary dissection on May 31, 1999. Pathological examination showed a 1-cm ILC, histological grade I, and no lymph node involvement. The immunohistochemical analysis showed high expression of ER (100%) and progesterone (PR, 100%) receptors.\nThe adjuvant chemotherapy AC regimen [Adriamycin 60 mg/m2 and cyclophosphamide 600 mg/m2, both on day (D) 1, every 21 days] was given for 4 cycles, followed by adjuvant radiotherapy and hormone therapy with tamoxifen 20 mg/day for 5 years until March 2005.\nIn May 2005, due to a recent onset of dyspeptic symptoms, the patient underwent an upper endoscopy, which showed an infiltrative lesion involving the bottom half of the proximal gastric body. The biopsy revealed adenocarcinoma, but an immunohistochemical analysis was not performed. The staging examinations showed no evidence of metastatic disease, and based on the hypothesis of a primary neoplasm of the stomach, the patient underwent a total gastrectomy. The immunohistochemical analysis performed later on the gastrectomy specimen showed ER and PR expression and a lack of HER2 expression, favoring the diagnosis of breast cancer recurrence in the gastric mucosa.\nAfter resection, based on the hypothesis of a second primary, there was no evidence of disease, and treatment was continued with adjuvant chemotherapy with 8 cycles of docetaxel 75 mg/m2. Afterward, the patient received hormone therapy with anastrozole, maintained until March 2009, when disease progression was detected in the bones. A new biopsy showed persistence of the previous immunohistochemical findings.\nAt that time, bone pain and dyspnea were noted upon moderate physical exercise. Chest tomography did not show lung parenchyma involvement, but there was a tapering distal to the right main bronchus suggestive of secondary involvement of the bronchial mucosa, which was confirmed by pathological examination (fig. ).\nThe patient underwent brachytherapy with a high dose of radiation (fig. , fig. ) for bronchial lesion treatment. In April 2009, first-line palliative chemotherapy with paclitaxel 80 mg/m2 on D1, D8 and D15, every 28 days, was started, in combination with Avastin 10 mg/kg on D1 and D15. Treatment was discontinued only in July 2010 due to bone disease progression detected by PET-CT.\nFrom July 2010 to November 2010, the patient received second-line hormone therapy with Faslodex, presenting symptomatic progression of bone disease after 5 months of treatment. In October 2010, third-line chemotherapy with capecitabine 1,750 mg/m2 from D1 to D14, every 21 days, was started. The patient maintained stable disease until October 2011, when she developed disease progression and was treated with everolimus plus an aromatase inhibitor. In March 2012, the patient presented with bone disease progression and was treated with radiotherapy. She developed an ocular metastasis when radiotherapy followed by chemotherapy (vinorelbine plus gemcitabine) was indicated. After new bone disease progression in July 2012, treatment was changed to liposomal doxorubicin 35 mg/m2 until October 2012, when a peritoneal metastasis was detected; carboplatin plus paclitaxel was initiated. The patient developed meningeal metastasis and died in January 2013.