Breast cancer metastasis to the stomach may mimic primary gastric cancer: report of two cases and review of literature

<p>Abstract</p> <p>Background</p> <p>The stomach is an infrequent site of breast cancer metastasis. It may prove very difficult to distinguish a breast cancer metastasis to the stomach from a primary gastric cancer on the basis of clinical, endoscopic, radiological and histopathological features. It is important to make this distinction as the basis of treatment for breast cancer metastasis to the stomach is usually with systemic therapies rather than surgery.</p> <p>Case presentations</p> <p>The first patient, a 51 year old woman, developed an apparently localised signet-ring gastric adenocarcinoma 3 years after treatment for lobular breast cancer with no clinical evidence of recurrence. Initial gastric biopsies were negative for both oestrogen and progesterone receptors. Histopathology after a D2 total gastrectomy was reported as T4 N3 Mx. Immunohistochemistry for Gross Cystic Disease Fluid Protein was positive, suggesting metastatic breast cancer. The second patient, a 61 year old woman, developed a proximal gastric signet-ring adenocarcinoma 14 years after initial treatment for breast cancer which had subsequently recurred with bony and pleural metastases. In this case, initial gastric biopsies were positive for both oestrogen and progesterone receptors; subsequent investigations revealed widespread metastases and surgery was avoided.</p> <p>Conclusion</p> <p>In patients with a history of breast cancer, a high index of suspicion for potential breast cancer metastasis to the stomach should be maintained when new gastrointestinal symptoms develop or an apparent primary gastric cancer is diagnosed. Complete histopathological and immunohistochemical analysis of the gastric biopsies and comparison with the original breast cancer pathology is important.</p

The association between the type, context, and levels of physical activity amongst adolescents

Background: Little is known about how the type and context of physical activity behaviors varies among adolescents with differing activity levels. The aim of this study was to assess differences in the type and context of physical activity behaviors in adolescents by level of objectively measured physical activity. Methods: Cross-sectional analysis of 2728 adolescents (1299 males, 1429 females) participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). The mean (SD) age was 13.8 (+0.1) years. Physical activity was measured using an Actigraph over 7 days. Adolescents were categorized into tertiles of activity (less, moderately, highly active) using counts/min and min/d of moderate-to-vigorous activity (MVPA). Activity type was reported using the Previous Day Physical Activity Recall (PDPAR). Differences in the type and context of activity by activity level were analyzed using Chi squared. Results: Highly active boys reported more job, outside, and sports activities on school days (P\u3c.05), and more sports activities on nonschool days (P\u3c.05). Highly active girls reported more outside activities on school days (P\u3c.05). Conclusions: Identifying the type and context of physical activity behaviors associated with more active adolescents, can help inform policy and physical activity interventions aimed at increasing activity levels in adolescents

Total adventitial resection of the cardia:'optimal local resection' for tumours of the oesophagogastric junction

INTRODUCTION: Little is published about the local resection of oesophageal cancers. We adopted the principles of rectal cancer surgery, ie standard surgical dissection techniques as well as standard pathological processing and reporting, and assessed the feasibility of applying them to oesophagogastric junction (OGJ) cancer. METHODS: Over a two-year period consecutive patients with invasive cancers of the OGJ were studied. Following staging and neoadjuvant chemotherapy (NAC), a standard dissection defined as a total adventitial resection of the cardia (TARC) was performed. Standard histopathological processing involved external inking, photographing, transverse slicing and mounting of cut samples on megablocks. Hospital morbidity and mortality as well as survival at five years' follow-up were assessed. RESULTS: Forty consecutive patients had a TARC for OGJ carcinoma. Of these, 32 were offered NAC. Introducing TARC did not result in increased morbidity or mortality. Twenty-seven patients (68%) had an R0 resection that was directly related to the tumour stage and significantly related to a response to chemotherapy. Sixteen patients (42%) were alive five years after their TARC operation. CONCLUSIONS: Although the adventitia of the OGJ is not as well developed as that of the rectum, TARC can be performed safely as a standardised resection for OGJ cancers. Whereas the R0 rate for early stage tumours is very high, it remains disappointingly low for T3N1 tumours despite NAC. Improved long-term survival for these advanced tumours will only be achieved with better neoadjuvant and adjuvant therapies

CT abdomen with oral contrast in patient 2 demonstrating thickening below the oesophagogastric junction (indicated by arrow) and residual right sided pleural effusion

<p><b>Copyright information:</b></p><p>Taken from "Breast cancer metastasis to the stomach may mimic primary gastric cancer: report of two cases and review of literature"</p><p>http://www.wjso.com/content/5/1/75</p><p>World Journal of Surgical Oncology 2007;5():75-75.</p><p>Published online 9 Jul 2007</p><p>PMCID:PMC1937002.</p><p></p