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Mucinous adenocarcinoma in colon with breast metastasis – case report
Apresentação do caso
A 78-year-old white woman from Pelotas/RS was referred with complaints of a right breast nodule, weight loss and anemia. Breast examination confirmed the right nodule which, at sonography, showed a solid mass with posterior acoustic shadowing with measurements of 4.2x2.6x4.4 cm located in the upper inner quadrant and classified as BI-RADS® US 4. Right breast setorectomy with sentinel lymph node biopsy samples were analyzed by histopathology. It was diagnosed as an interstitial mucinous carcinoma with immunohistochemical screening resulting in negative reaction for estrogen and progesterone receptors, but with positive cells for CDX2 and CK20. Colonoscopy revealed a vegetating mass that hampered the forward displacement of the laparoscope in ascending colon and the mass biopsy was performed, revealing an ulcerated colon adenocarcinoma mildly differentiated. Ileocolectomy was undergone for primary focus resection.
Metastasis to the breast from colon adenocarcinoma is rare, with less than 10 cases reported in the literature until now. Thus, immunohistochemical analysis can provide some clues to the primary site of carcinoid tumours. Expression of CDX2 and CK20 favours gastrointestinal origin with colorectal carcinoma cells positive for CK20, whereas this is exceptional in primary breast carcinoma.
Finally, the surgical treatment of a secondary breast tumor should be both diagnostic and palliative, with poor prognosis.
Mucinous adenocarcinoma, breast metastasis, CDX2, CK20
Tumores colorretais e canal anal
MARCO AURÉLIO VEIGA CONRADO, ANDRÉ LUIZ VEIGA CONRADO, PEDRO SANTOS GUIMARÃES, MAHAR MUHAMMAD BILAL, EDUARDO REIS, MARCOS MOREIRA PEREIRA, AUGUSTO NOBRE KABKE, LUCIANO NIEMEYER GOMES, CASSIO MELLO TEIXEIRA, RICARDO LANZETTA HAACK