Premenstrual sub-occlusive episodes as initial presentation of metastatic breast cancer: a case report of a previously undescribed entity

Across the globe, breast cancer remains the most common malignancy in women. Although novel therapies introduced during the last years have helped reducing its mortality, nevertheless it remains a major public health problem associated with considerable financial burden on healthcare systems and psychological strain on patients and their families. Breast cancer spreads most commonly to the bones, lungs and central nervous system and its metastasis accounts for the most common cause of death of this malignancy. We report an uncommon primary symptomatology for breast cancer. Those symptoms consisted of premenstrual obstipation episodes associated with scant non bilious vomiting and diffuse abdominal pain for a period of 5 months. Although previous cases of breast cancer metastases to the gastrointestinal tract have been reported in the literature, to the best of our knowledge this is the first article to describe such an initial symptomatology. After a complex diagnostic workup, the patient was diagnosed with a neoplastic mammary growth at the level of the ileocecal valve. We describe this unusual clinical manifestation, the exhaustive diagnostic workup that was needed and provide updates concerning the current knowledge of tumor metastasis. This case introduces the potential novel entity of cyclical hormone-dependent incomplete luminal blockage and the multifaced and misleading clinical presentation it may generate. Furthermore, we also aim to raise awareness concerning atypical metastatic breast cancer clinical manifestations and emphasize the need to remain vigilant towards them because would definitely lead to a faster management and better outcome. This article could also provide input and trigger further research to unravel the mechanisms of those unusual pattern of metastatic dissemination.