PMC3262580_01
CT scan shows small bowel dilatation, no other specific features.
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A CT scan showed evidence of small bowel obstruction (Figure 1); a laparotomy and resection of a thickened and narrowed terminal ileum were carried out followed by bowel anastomosis.
CT scan reveals left hydronephrosis secondary to compression on lower ureter by a rectal mass, previous right nephrectomy.
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Staging CT scan identified left hydronephrosis caused by compression on the ureter from the metastasis in the rectum (Figure 2).
View at sigmoidoscopy showing narrowed lumen, which was felt to be due to a firm and swollen mucosa by the endoscopist.
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Unfortunately, 3 months later, the patient had new episodes of diarrhoea with fresh blood; sigmoidoscopy showed a narrowed lumen and firm swollen mucosa at the upper rectum (Figure 3); biopsies revealed the presence of metastatic lobular carcinoma of breast, the tumour foci stained positive with cytokeratin 7 (CK7), pancytokeratins, and ER.
Small bowel mucosa infiltrated by cords of metastatic lobular adenocarcinoma cells. (Haematoxylin and eosin, original magnification x400.)
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The histological analysis confirmed the presence of widely infiltrated small bowel by well-differentiated epithelial cells, some of which contained intracytoplasmic lumina and formed a single file pattern of infiltration (Figure 4).
The same slide stained with antibody to estrogen receptor. The malignant cells stain brown (ER clone 6F11, original magnification x400).
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The appearances were those of metastatic lobular carcinoma of breast, which was ER positive and E-cadherin & Her 2 negative (Figure 5), invaded the mucosa, the mesentery, and appeared to extend beyond the mesenteric margins of excision.