Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma.

BACKGROUND: Breast carcinoma is the most common malignancy in women. Metastatic involvement of the stomach is not well known.
METHODS: Endoscopic features and treatment options were evaluated retrospectively for 51 patients with gastric metastases of breast carcinoma.
RESULTS: The presenting sites of metastases were skeleton (43%), stomach (27%), lung (8%), and liver (4%). Diagnosis of gastric involvement was histologically confirmed in 41 patients and based on endoscopic features, despite negative biopsies in 10 patients. Six patients (12%) presented with nonfatal hemorrhage; in the others, symptoms were nonspecific: anorexia (71%), epigastric pain (53%), and vomiting (41%). Endoscopy showed 3 patterns: 18% localized lesions, 57% diffuse infiltration, and 25% external compression at the cardia or pylorus. Histology showed mainly lobular breast carcinoma (n = 36) compared with ductal carcinoma (n = 10) and other types (n = 5), contrary to the usual distribution. The overall response to systemic therapy was 46% (17 of 37 treated patients). Median survival from detection of gastric metastases was 10 months, with a 2-year survival rate of 23%.
CONCLUSIONS: Gastric metastases usually derive from lobular rather than ductal breast carcinoma. Endoscopy revealed mainly a diffuse linitis plastica-like infiltration. Chemotherapy or hormonal treatment may result in fair palliation in selected patients, although many patients are heavily pretreated.