Brain Metastases after Bilateral Breast Cancer

45 yo AAF with PMH of (B) breast cancer with metastases to lungs and to the brain, S/P (B) mastectomies is admitted to the hospital with CC: abdominal pain for one month. The pain has gradually increased in intensity over one month. She describes the pain as sharp and deep inside of her abdomen, centrally. She denies diarrhea. The patient grades the pain as 9/10 and it is accompanied by N/V. She denies black or tarry stools and has had no difficulty urinating. She denies fever and chills. She also c/o headache.

PMH:
(B) breast cancer with metastases to lungs and brain for which she is receiving radiation therapy

PSH:
(B) mastectomies, hysterectomy and two cesarean sections, MediPort inserted into the left anterior chest

Medications:
Zofran, Prilosec, lisinopril, glipizide, dexamethasone, morphine

SH:
She is one of 12 children, specifically 10 females

FMH:
Maternal breast cancer as well as six sisters with breast cancer

Physical examination:
VS 36-169/98-79-18
Dry MM
Chest: CTA (B)
CVS: Clear S1S2
Abd: Soft, NT, ND, +BS
Extremities: +2 pitting edema of upper extremities secondary to mastectomies (B)
Neuro: nonfocal

CT of the head:


Brain mets


Brain mets

What happened?
Patient had a NG tube which provide some relief from N/V. She had difficulty swallowing and CT of the abdomen showed a mass at the GE junction.

EGD revealed an external ulcerating mass pressing on the GE junction.

These findings were discussed with the patient, her family and the surgeon. Her wishes were to proceed with the surgery.

Patient had a surgical excision of the mass and anastomosis to circumvent the obstruction. She improved and was discharged home to follow with her oncologist. The pathology report of the mass showed metastatic breast carcinoma.

2 comments:

  1. =Why was she not given CT(chemotherapy)following (B)mastectomies?
    -Why was she not on any antiestrogens following mastectomy? Was the resected tumor not screened for ER/PR receptors?
    -Was the EGD done without a biopsy to reveal the HPE?

    Clinically, she was a fit pt for surgical relief of the upper G.I obstn considering her age & clinical status. However it was surprising to note that CT was not given for this pt with such a strong family h/o & known mets to lungs& brain. I was just wondering the histological type of this breast CA?

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  2. It sounds like that was an end-stage cancer at the time of presentation for this particular case. Wasn't it featured in the Neurology section to illustrate brain mets?

    SP's question focus mostly on breast cancer management. That was not the main point here.

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