D Anusheel Anchal Vasnik. (2025). Bila e al In il a ing Duc al B eas Ca cinoma wi h Gas ic Me as asis:
A Ra e Case. MAR Oncology and Hema ology. (2025) 5:10
Bila e al In il a ing Duc al B eas Ca cinoma wi h Gas ic
Me as asis: A Ra e Case
D Anusheel Anchal Vasnik 1*, D P adeep Chand aka 2, D . Vi ek Choudha y 3
1. Senio Residen , Radia ion Oncology, Regional Cance Cen e , Raipu .
2. P o esso , Radia ion Oncology, Regional Cance Cen e , Raipu .
3. P o esso and HOD, Radia ion Oncology, Regional Cance Cen e , Raipu .
*Co espondence o: D Anusheel Anchal Vasnik, Senio Residen , Radia ion Oncology, Regional Cance
Cen e , Raipu .
Copy igh .
© 2025 D Anusheel Anchal Vasnik, This is an open access a icle dis ibu ed unde he C ea i e Commons
A ibu ion License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided
he o iginal wo k is p ope ly ci ed.
Recei ed: 21 Oc obe 2025
Published: 10 Sep embe 2025
MAR Oncology and Hema ology (2025) 5:10
Case Repo
D Anusheel Anchal Vasnik, MAR Oncology and Hema ology (2025) 5:10.
Page 2 o 9
D Anusheel Anchal Vasnik. (2025). Bila e al In il a ing Duc al B eas Ca cinoma wi h Gas ic Me as asis:
A Ra e Case. MAR Oncology and Hema ology. (2025) 5:10
1. Backg ound
Me as a ic b eas ca cinoma is qui e equen in Indian scena ios, especially among women om high
socioeconomic s a a. As pe he ICMR da a published in 2020, b eas ca cinomas accoun o 57%, only a e
ce ix – u e i cance (60%) o he o al cance bu den in India.[1] In ou ins i u e, 10.68% pa ien s o ca cinoma
b eas ha e been egis e ed in he las 10 yea s. Globally b eas cance is he commones cance in emales
and now has su passed ce ical cance as he leading cause o global cance incidence in yea 2020, wi h an
es ima ed o 2.3 million new cases, ep esen ing 11.7% o all cance cases.[2] O e he las 26 yea s, he age-
s anda dized incidence a e o BC in emales inc eased by 39.1%, wi h he inc ease obse ed in e e y s a e o
he coun y, om 1990 o 2016. [3,5] As pe he Globocan da a 2020, in India, b eas cance accoun ed o
10.6% (90408) o all dea hs and 13.5% (178361) o all cance cases.[4] Gas ic me as asis om o he si es is
a e, bu oge he wi h malignan melanoma and lung cance , b eas cance seems o ha e he g ea es capaci y
o me as asize in he gas oin es inal ac .[6] Radiological and endoscopic indings a e nonspeci ic, and may
be ha d o dis inguish om p ima y gas ic cance and non-Hodgkin’s lymphoma. In such condi ions we need
o ely on endoscopic guided biopsy wi h his opa hology and immunohis ochemis y o he inal diagnosis.
Abs ac
App oxima ely 25% o emale cance cases a e b eas cance in India, wi h high incidence be ween
25 y s and 40 y s. Bila e al b eas cance is usually a e and p esence o gas ic me as asis is e en
a e . When such pa ien s p esen s wi h signs and symp oms o me as a ic disease as he chie
complain , i is e y di icul o ind ou p ima y. We epo a case o a o y-yea -old woman, who
p esen ed wi h complains o dysphasia and omi ing a e ha ing meals since one mon h. He
Endoscopy and biopsy ou side sugges ed gas ic ca cinoma. On P elimina y examina ion a ou cen e
e ealed ha he pa ien has bila e al b eas lumps wi h mul iple lymph nodes in bila e al ce ical and
axilla y egions. Mul iple biopsies we e aken and IHC was pe o med om bo h gas ic and b eas
issue which concluded ou inal diagnosis as in il a ing duc al ca cinoma b eas wi h gas ic
me as asis.
Keywo ds: b eas , ca cinoma, gas ic, dysphagia, IHC, in il a ing duc al ca cinoma.
D Anusheel Anchal Vasnik, MAR Oncology and Hema ology (2025) 5:10.
Page 3 o 9
D Anusheel Anchal Vasnik. (2025). Bila e al In il a ing Duc al B eas Ca cinoma wi h Gas ic Me as asis:
A Ra e Case. MAR Oncology and Hema ology. (2025) 5:10
2. Case Repo
A o y-yea -old emale came wi h abdominal pain, omi ing a e meals, e e and loss o appe i e since six
mon hs. She wen o a gas oen e ologis , whe e endoscopy e ealed ulce s in he s omach, wi h s ic u e in
duodenum and sigmoid colon. Biopsy om s omach ulce s e ealed di use in il a ing adenoca cinoma o
signe ing pheno ype. She was e e ed o ou cen e o u he managemen as gas ic cance . On ho ough
clinical examina ion, well de ined lump we e ound in bo h b eas wi h mul iple bila e al axilla y lymph nodes.
The e we e bila e al ce ical, uppe , middle, lowe jugula and sup acla icula lymph nodes. Sonog aphy also
con i med same inding. He CECT scan o abdomen e ealed ci cum e en ial hickening in ol ing ileo –
caecal junc ion and caecum wi h mul iple pa a-ao ic lymph nodes. Bila e al adenexa we e bulky and non –
enhancing. Lung showed no abno mali y.
Biopsy om bila e al b eas lumps and le axilla y lymph node e ealed in asi e b eas ca cinoma wi h
ea u es highly suspicious o in asi e lobula ca cinoma. Due o unusual indings, IHC was sen . IHC om
b eas biopsy was posi i e o E-cadhe in, CK-7, TRPS and Es ogen Recep o s whe eas Ki-67 was 25%. IHC
om gas ic biopsy was posi i e o CK-7 and TRPS bu nega i e o CDX-2 and He -2 Neu. Consequen ly,
he diagnosis a i ed as in il a ing duc al ca cinoma b eas wi h gas ic me as asis. The pa ien was s a ed on
chemo he apy as me as a ic b eas cance wi h injec ion albumin bound Pacli axal (260mg/m2) and injec ion
Ca bopla in (AUC-6). The pa ien is unde chemo he apy and doing be e han be o e.
3. Discussion
Ou pa ien was ini ially suspec ed as gas ic ca cinoma. A e clinical e alua ion and u he in es iga ions,
i was inally concluded as b eas ca cinoma wi h gas ic me as asis. I ’s because ca cinoma b eas shows a
simila pic u e o signe ing cells as p ima y gas ic ca cinoma which makes i di icul o diagnose.
Fu he mo e p ima y gas ic ca cinoma can also me as asize o b eas which can u he complica e he
diagnosis.[7] Only IHC inding has con i med diagnosis.
The incidence o b eas cance me as asis o he s omach in long e m ollow up and pos mo em cases has
been es ima ed a 2-18%.[8]
Ou pa ien p esen ed wi h complains o ano exia, weigh loss, omi ing a e meals and abdominal pain which
makes hem indis inguishable om p ima y gas ic ca cinoma. XU e al, also con i med ha dull aching
abdominal pain was mos common symp om and localized o epigas ic egion which may mimic pep ic ulce
disease and eli es a e ea ing. .[7] Gas ic me as asis can occu synch onously wi h o he si es o me as asis,
so i ’s e y impo an o ho oughly examine he pa ien s which may p o ide accu a e diagnosis o he
clinician.[9]
D Anusheel Anchal Vasnik, MAR Oncology and Hema ology (2025) 5:10.
Page 4 o 9
D Anusheel Anchal Vasnik. (2025). Bila e al In il a ing Duc al B eas Ca cinoma wi h Gas ic Me as asis:
A Ra e Case. MAR Oncology and Hema ology. (2025) 5:10
Ou pa ien had di use in il a ion o submucosa and muscula is p op ia gi ing a pic u e o lini us plas ica in
con as enhanced CT scan, which is he mos common pa e n o b eas cance me as asis. Di use in amu al
in il a ion imi a ing lini us plas ica in gas ic me as asis pa ien s was epo ed o be 78% by Madeya and
Bo sch.[10] Ou indings was consolida ed by he indings o Co mei e al, which concluded ha lini us
plas ica is he mos common pa e n o in ol emen in gas ic me as asis.[11].
Figu e 1: CT Scan o S omach
On uppe GI endoscopy, mul iple ulce s we e p esen in he s omach which coincide wi h he indings o
Gio anni e al, whe e ulce a i e lesion o polypoidal and ex insic mass lesions we e common indings.[12]
Diagnos ic imaging a ely helps he pa ien ’s diagnosis. Uppe GI endoscopy wi h deep biopsy is conside ed
as he bes modali y o iden i y such me as asis. [6,12]
Figu e 2: UGI o S omach
D Anusheel Anchal Vasnik, MAR Oncology and Hema ology (2025) 5:10.
Page 5 o 9
D Anusheel Anchal Vasnik. (2025). Bila e al In il a ing Duc al B eas Ca cinoma wi h Gas ic Me as asis:
A Ra e Case. MAR Oncology and Hema ology. (2025) 5:10
Ou pa ien ’s his opa hology and IHC con i med he diagnosis o in il a ing duc al ca cinoma b eas wi h
gas ic me as asis which is a e, as o he s udies show ha gas ic me as asis is mo e equen wi h in il a ing
lobula ca cinoma (65.4%) han in il a ing duc al ca cinoma (24.4%).[5] Taal e al, epo ed 83% pa ien s o
p ima y lobula ca cinoma had gas ic me as asis.[13] Bo sch e al, obse ed he e is dis inc pa e n o
me as asis in bo h a ie ies. In il a ing lobula ca cinoma me as a ize o gas oin es inal ac s, pe i oneum,
gynecological o gans whe eas in il a ing duc al ca cinoma p e e s lung, li e and bones making i much mo e
unlikely.[10]
Mo phologically, i is e y di icul o dis inguish be ween signe ing cell appea ances o p ima y gas ic
ca cinoma and b eas ca cinoma. Howe e , CHU e al, obse ed b eas signe - ing cell ca cinoma may show
some mo phological di e ences om gas ic and colonic signe - ing cell ca cinoma. In b eas a single, well-
ci cumsc ibed uni acuola ed in a – cy oplasmic lumina, wi h a cen al eosinophilic inclusion we e seen,
whe eas in o he signe - ing cell ca cinoma he cells ha e ex ended, globoid, and op ically clea cy oplasmic
acid mucin ha pushes he nuclei agains he cell memb ane.[14]
Figu e 3: His opa hology o B eas Biopsy Figu e 4: His opa hology o Gas ic Biopsy
In many s udies, high pe cen age o me as a ic b eas ca cinomas a e posi i e o es ogen ecep o s- ER
(72%), p oges in ecep o s- PG (33%), o G oss Cys ic Disease Fluid P o ein GCDFP 15 (78%) and o
cy oke a in 5/6 (61%), whe eas p imi i e gas ic cance s a e nega i e o all hese biological
ma ke s.[15,16,17] IHC in b eas biopsy was posi i e o es ogen ecep o s, CK-7 and TRPS whe eas Ki-67
came ou o be 25%. Also E-cadhe in was e ained p o ing i o be in il a ing duc al ca cinoma b eas .
Whe eas IHC on gas ic biopsy was nega i e o CDX-2 and posi i e o CK-7 and TRPS – 1, p o ing ha
p ima y b eas umo and hei me as ases a e pheno ypically simila . P ima y gas ic ca cinoma is mo e
equen ly posi i e o CK20 (50%), MUC 2 (54%), MUC5AC (71%), MUC 6 (39%), DAS-1 (43%) and
D Anusheel Anchal Vasnik, MAR Oncology and Hema ology (2025) 5:10.
Page 6 o 9
D Anusheel Anchal Vasnik. (2025). Bila e al In il a ing Duc al B eas Ca cinoma wi h Gas ic Me as asis:
A Ra e Case. MAR Oncology and Hema ology. (2025) 5:10
CDX2 (67%) compa ed wi h me as a ic b eas cance , which shows nega i i y o all hese ma ke s excep
MUC2, which is posi i e in 25% o cases. [15,16,17]
Figu e 5: Es ogen Recep o Posi i e in B eas IHC Figu e 6: CK - 7 Posi i e in B eas IHC
Figu e 7: E - Cadhe in Posi i e in B eas IHC Figu e 8: KI - 67 Ac i i y in B eas IHC
Figu e 9: CK–7 Posi i e in Gas ic IHC Figu e 10: TRPS Posi i e in Gas ic IHC
D Anusheel Anchal Vasnik, MAR Oncology and Hema ology (2025) 5:10.
Page 7 o 9
D Anusheel Anchal Vasnik. (2025). Bila e al In il a ing Duc al B eas Ca cinoma wi h Gas ic Me as asis:
A Ra e Case. MAR Oncology and Hema ology. (2025) 5:10
IHC MARKERS
RESULT
E – cadhe in
Re ained
CK-7
Posi i e
ER
S ongly posi i e
Ki-67
25%
TRPS – 1
Posi i e
IHC MARKERS
RESULT
CK-7
Posi i e
CDX-2
Nega i e
HER -2 NEU
Nega i e
TRPS – 1
Posi i e
Table 1: IHC om B eas Tissue Table 2: IHC om Gas ic Tissue
The ype o he apy ha is gi en o he pa ien depends upon he age, clinical p esen a ion, a ailabili y o
he apeu ic op ions and quali y o li e discussion. A s udy by Mclemo e e al epo ed he o e all median
su i al o 28 mon hs in 73 pa ien s wi h gas oin es inal me as asis om b eas cance , also p edic ing
ea men wi h chemo he apy o a ge ed he apy ha ing a posi i e e ec on su i al whe eas ad anced age
o diagnosis and gas ic me as asis ha ing a nega i e impac .[18]
Su ge y being a deba able ea men op ion in such pa ien s, is only ese ed o soli a y nodula lesion o in
cases o obs uc ion, bleeding o pe o a ion. Radio he apy doesn’ ha e a majo ole ei he in such pa ien s
and is ese ed o pallia i e managemen .
In conclusion gas ic me as asis om b eas cance is a e. In such cases pa ien s coming wi h p ima y gas ic
ca cinoma should unde go a ho ough clinical and adiological examina ion. Comple e His opa hological and
immunohis ochemical analysis is equi ed o he inal diagnosis o me as a ic b eas ca cinoma. Pallia i e
and ho monal chemo he apy used in ho mone posi i e b eas ca cinomas a e he mos help ul choices o
ea men in such cases.
D Anusheel Anchal Vasnik, MAR Oncology and Hema ology (2025) 5:10.
Page 8 o 9
D Anusheel Anchal Vasnik. (2025). Bila e al In il a ing Duc al B eas Ca cinoma wi h Gas ic Me as asis:
A Ra e Case. MAR Oncology and Hema ology. (2025) 5:10
Re e ences
1. Ma hu P, Sa hishkuma K, Cha u edi M, Das P, Suda shan KL, San happan S, Nallasamy V, John A,
Na asimhan S, Roselind FS, Icm -Ncdi -Nc p In es iga o G oup. Cance s a is ics, 2020: epo om na ional
cance egis y p og amme, India. JCO global oncology. 2020 Jul;6:1063-75.
2. Sung H, Fe lay J, Siegel RL, La e sanne M, Soe joma a am I, Jemal A, B ay F. Global cance s a is ics
2020: GLOBOCAN es ima es o incidence and mo ali y wo ldwide o 36 cance s in 185 coun ies. CA: a
cance jou nal o clinicians. 2021 May;71(3):209-49.
3. In e na ional Agency o Resea ch on Cance . India Sou ce: Globocan 2020.[ci ed 11 June 2021].
4. Meh o a R, Yada K. B eas cance in India: P esen scena io and he challenges ahead.
Wo ld Jou nal o Clinical Oncology. 2022 Ma 3;13(3):209.
5. Madha MR, Nayagam SG, Biyani K, Pandey V, Kamal DG, Saba imu ugan S, Ramesh N, Go handam
KM, Jaya aj R. Epidemiologic analysis o b eas cance incidence, p e alence, and mo ali y in India: P o ocol
o a sys ema ic e iew and me a-analyses. Medicine. 2018 Dec;97(52).
6. Ismael AT, Jalal JA, Hussein S, Jawha NM, Sha eek MY, Abdul azaq R. Me as a ic B eas Cance o
S omach Mimicking P ima y Gas ic cance . Innd 2 Hawle Pha maceu ical Sciences Con e ence: HPSC 2019
No embe 13-14, 2019 2019 No 13
(p. 60).
7. Bou is AL, And eadis C, Pa akiou a F, Mou a idou D. Gas ic signe - ing
adenoca cinoma p esen ing wi h b eas me as asis. Wo ld jou nal o gas oen e ology: WJG. 2006 May
5;12(18):2958.
8. Jones GE, S auss DC, Fo shaw MJ, Dee e H, Mahede a U, Mason RC. B eas cance me as asis o he
s omach may mimic p ima y gas ic cance : epo o wo cases and e iew o li e a u e. Wo ld Jou nal o
Su gical Oncology. 2007 Dec;5(1):1-6.
9. Xu L, Liang S, Yan N, Zhang L, Gu H, Fei X, Xu Y, Zhang F. Me as a ic gas ic cance om b eas
ca cinoma: A epo o 78 cases. Oncology le e s. 2017 Oc 1;14(4):4069-77.
10. Madeya S, Bö sch G. Gas oin es inal me as ases o b eas ca cinoma. Gas oin es Endosc. 1993 Jan-
Feb;39(1):103-4. doi: 10.1016/s0016-5107(93)70029-2. PMID: 8267696.
11. Co mie WJ, Ga ey TA, Welch JM, Welch JS, Edmonson JH. Lini is plas ica caused by me as a ic lobula
ca cinoma o he b eas . InMayo Clinic P oceedings 1980 Dec 1 (Vol. 55, No. 12, pp. 747-753).
12. De Palma GD, Masone S, Rega M, Simeoli I, Donisi M, Addeo P, Iannone L, Pilone V, Pe sico G.
Me as a ic umo s o he s omach: clinical and endoscopic ea u es. Wo ld jou nal o gas oen e ology: WJG.
2006 Dec 12;12(45):7326.
D Anusheel Anchal Vasnik, MAR Oncology and Hema ology (2025) 5:10.
Page 9 o 9
D Anusheel Anchal Vasnik. (2025). Bila e al In il a ing Duc al B eas Ca cinoma wi h Gas ic Me as asis:
A Ra e Case. MAR Oncology and Hema ology. (2025) 5:10
13. Taal BG, Pe e se H, Boo H. Clinical p esen a ion, endoscopic ea u es, and ea men o gas ic me as ases
om b eas ca cinoma. Cance : In e disciplina y In e na ional Jou nal o he Ame ican Cance Socie y. 2000
Dec 1;89(11):2214-21.
14. Chu PG and Weiss LM: Immunohis ochemical cha ac e iza ion o signe - ing cell
ca cinomas o he s omach, b eas , and colon. Am J Clin Pa hol 121: 884-892, 2004.
15. O'Connell FP, Wang HH, Odze RD. U ili y o immunohis ochemis y in dis inguishing p ima y
adenoca cinomas om me as a ic b eas ca cinomas in he gas oin es inal ac . A chi es o pa hology &
labo a o y medicine. 2005 Ma 1;129(3):338-47.
16. K ishnamu hy S. U ili y o immunohis ochemis y in dis inguishing p ima y
adenoca cinomas om me as a ic b eas ca cinomas in he gas oin es inal ac . B eas Diseases.
2006;16(4):355-6.
17. Ghi a duzzi A, Si elli R, Ma ella E, Bella M, De Simone B, A cu i MF, Zannoni M, Del Rio P, Sianesi
M. Gas ic me as asis om b eas ca cinoma. Repo o h ee cases,
diagnos ic- he apeu ic c i ical close examina ion and li e a u e e iew. Annali I aliani di Chi u gia. 2010 Ma
1;81(2):141-6
18. McLemo e EC, Pockaj BA, Reynolds C, G ay RJ, He nandez JL, G an CS, Donohue JH. B eas cance :
p esen a ion and in e en ion in women wi h gas oin es inal me as asis and ca cinoma osis. Annals o su gical
oncology. 2005 No ;12:886-94.
Med onic
