Surgeons

Colonic metastasis from breast carcinoma is extremely rare. Bony, pulmonary, pleural, hepatic and cerebral metastases are common. Here we discuss rare colonic metastatic presentation of a primary breast malignancy. A 72 year old female presented with a left breast mass in 1991 treated with breast conserving surgery, axillary clearance and adjuvant radiotherapy.Six years later she developed bony metastases requiring endocrine therapy and bisphosphonates. Following this, she was diagnosed with ovarian metastases requiring total abdominal hysterectomy and bilateral salpingo-oophorectomy. New retroperitoneal disease was detected subsequently on surveillance imaging mandating Aromasin reinstitution. Routine bowel screening few years later revealed a sigmoid growth histologically consistent with metastatic breast cancer, PET scan confirmed a locally invading proximal sigmoid mass. Anterior resection of mass was performed. Tissue was immuno histochemically

consistent with metastatic breast primary with nodal involvement. We present a rare case of breast cancer metastases to sigmoid colon that was detected on routine surveillance colonoscopy for polypoid disease and herewith, emphasize the importance of biopsying bowel polyps in the context of prior breast cancer, providing the pathologist with this crucial information for timely diagnosis. There are emerging case reports of this uncommon occurrence, which can also present with symptoms of dyspepsia,anemia and bowel occlusion. Early investigation with PET scan may aid timely diagnosis. Indications for surgery should be based on the risk of intestinal occlusion or bleeding. Clinical management can be challenging. Holistic care should be delivered via multidisciplinary approach.