A271 GASTRIC METASTASES FROM PRIMARY BREAST CANCERS PRESENTING AS RARE CAUSES OF COMMON GASTROINTESTINAL DISORDERS

Breast cancer is the most common malignancy in women worldwide and contributes to high morbidity and mortality. Metastases to the gastrointestinal tract are rare and present with a wide variability clinically and endoscopically. We report 2 cases of gastric metastases from primary breast cancers to highlight the variability in clinical and endoscopic presentations. Two cases were identified in clinical practice and included in this case series. Case 1 A 31-year-old woman presented with a 2-day history of severe nausea, vomiting, and 1 episode of frank hematemesis with a hemoglobin drop from 104 to 82 g/L. She had a history of PR-/ER+/Her2- right ductal carcinoma, treated with mastectomy and adjuvant chemotherapy. CT scan 8 months later revealed disease recurrence with metastases to the pancreas, liver, and kidney. EGD revealed multiple homogenous nodules with central ulceration over the proximal body of the stomach, extending to the fundus (Fig. 1a). The nodules were hard and not amenable to clipping. There was no evidence of active bleeding. Hemospray was used to prevent rebleeding. Nodule biopsies were positive for poorly differentiated adenocarcinoma and consistent with primary ductal carcinoma. The patient continued a pantoprazole infusion for 72 hours with no further GI bleeding or hemoglobin drop. Adjuvant endocrine therapy was attempted but poorly tolerated. Due to extensive disease burden, she opted for palliation. Case 2 An 84-year-old woman presented with a 6-month history of intermittent dysphagia, early satiety, and weight loss. She had a history of invasive left ductal carcinoma 17 years ago, treated with radiation and adjuvant endocrine therapy. Eight years later she developed ER+/PR+/Her2- lobular carcinoma in the same breast, treated with radical mastectomy and axillary node dissection and adjuvant tamoxifen. EGD revealed esophageal strictures, likely secondary to past radiation therapy. The strictures were dilated for dysphagia management. Gastric mucosa was seen with increased folds, but without discrete ulcers or lesions (Fig. 1g). Biopsies were taken to rule out H. pylori, but returned positive for adenocarcinoma. Immunohistochemistry was consistent with lobular breast carcinoma. Further CT scan revealed new bone, neck, and mediastinal metastases. She deteriorated clinically over a few months and opted for palliation. Gastric metastases can have variable, non-specific clinical and endoscopic presentations. Symptoms may include nausea, vomiting, early satiety, weight loss, and GI bleeding. Endoscopic appearance may range from prominent gastric folds to discrete ulcerating lesions. While rare, our cases demonstrate that gastric metastases should be considered in patients with breast cancer history presenting with gastrointestinal symptoms, as morbidity and mortality is high in these cases. None

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