Metastasis from
breast cancer to the gastrointestinal (GI) tract is uncommon, and such events presenting as GI
bleeding are exceedingly rare. In some individuals, the absence of classical findings of primary
breast cancer coupled with the non-specific nature of GI symptoms may make early detection and diagnosis challenging. Our patient is a 75-year-old female who presented with symptomatic anemia manifesting as progressive
dizziness, weakness, and early satiety that developed eight days after right
knee arthroplasty. She had a remote history of
acid reflux disease and reported regular use of non-steroidal anti-inflammatory drugs (
NSAIDs). Physical examination was notable for pallor and
tachycardia; the cardiopulmonary examination was otherwise unremarkable and the abdominal examination was normal. A fecal occult blood test was positive. Subsequent esophagogastroduodenoscopy demonstrated significant erosive
gastritis and
duodenitis that was initially attributed to the patient's
NSAID use. However, biopsy showed signet ring
carcinoma. No gastric primary
tumor was identified on work up. Extensive evaluation ultimately revealed invasive
lobular carcinoma of the breast. Notably, no primary breast lesion had been detected on physical examination or breast mammography or magnetic resonance imaging (MRI).
Therapy for invasive
lobular carcinoma of the breast is substantially different from gastric
carcinoma and thus it is important to accurately diagnose the condition early in its course to optimize patient outcomes.