Abdul H. Khan, MD; Christopher C. Thompson, MD, MHES; David L. Carr-Locke, MD, FRCPSeries Editor: David L. Carr-Locke, MD, FRCP

Disclosures

May 16, 2005

Discussion

This report presented a case of chronic watery diarrhea in a patient with pancolitis on CT scan. Initially, it seemed that the diarrhea was most likely due to an infection because it had started while the patient was on a cruise in Mexico and she was known to have bone metastases (which could make her relatively neutropenic). In addition, she was on chronic prednisone, an immunosuppressant, for congenital adrenal hyperplasia. However, all stool studies were negative for signs of infection, and the colonic biopsies were negative for viral infection. The diffuse submucosal hemorrhages found on endoscopy were an unusual finding, and at the time of the procedure, their significance was unclear. Despite the fact that the patient had known metastatic breast cancer, it was quite surprising that the biopsies revealed infiltrative carcinoma because no mass was seen on endoscopy.

Breast cancer is recognized as the most common cancer in women. In 2004, over 200,000 women were diagnosed with breast cancer in the United States,[2] and it is estimated that 1 in 8 women will develop breast cancer. After initial treatment with surgery and chemoradiation, the risk of disease recurrence is highest within years 2-5, as was the case in this patient, who had a recurrence in the contralateral breast 3 years after initial diagnosis.[3] Breast cancer can metastasize to many locations and the most common sites are bones, lungs, and liver.[4] It is very uncommon for this malignancy to metastasize to colon, and a diffuse colitis-type pattern for breast cancer metastases is very unusual; only 1 such case report could be found in a review of the literature.[5] Presumably, the pathophysiology of diarrhea in this patient is due to decreased fluid absorption capability by the colon as a result of diffuse infiltration of tumor cells throughout the colon. This case illustrates that metastases can integrate into a distant organ in a diffuse pattern resulting in unusual clinical findings, such as the submucosal hemorrhages seen on endoscopy.

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