Breast Cancer Metastasis to the Gastrointestinal Tract After Nine Years of Remission: A Case Report

Gastrointestinal (GI) metastasis from breast cancer is rare and more commonly associated with invasive lobular carcinoma than invasive ductal carcinoma (IDC). Diagnosis of GI metastases secondary to breast cancer is difficult because patients may have long disease-free intervals or present with non-specific symptoms. We present a case of a 55-year-old patient with high-grade IDC in nine-year remission after bilateral mastectomy, axillary node dissection, reconstruction, and adjuvant chemoradiation who presented with recurrent abdominal pain and progressive, cholestatic liver enzyme elevation. Imaging and endoscopic evaluations demonstrated hepatic and duodenal lesions and biliary strictures. Biopsy confirmed the diagnosis of recurrent Stage IV IDC with metastasis to the duodenum, liver, lymph nodes, and spine. The patient received palliative systemic therapy and survived three years after recurrence diagnosis. Our case emphasizes that metastasis of IDC to the GI tract can occur after prolonged remission and that cholestatic liver enzyme elevation with new hepatic or biliary abnormalities should prompt consideration of metastatic recurrence in patients with a prior history of breast cancer.