Periampullary Metastases from Breast Cancer: A Case Report andLiterature Review

We presented a metastatic breast cancer case who was afflicted with obstructive jaundice caused by an ampullary neoplasm. Sincejaundice due to periampullary metastasis from breast cancer was a rare entity, a literature review of similar cases through thePubMed database was done. A total of 23 additional cases were found. Among these 24 cases, 5 presented with periampullarymetastasis synchronously with the diagnosis of breast cancer, while 19 had metachronous periampullary metastasis with aninterval ranging between 1.3 and 23 years from the initial diagnosis of breast cancer to the emergence of jaundice. It isintriguing to establish a differential diagnosis for common bile tract stricture prior to tissue biopsy, even with diagnosticworkups including serum tumor markers, MRI plus MRCP, ERCP with intraductal brushing, and endoscopic ultrasound, in thatthe clinical, radiological, and endoscopicfindings of metastatic lesions overlapped extensively with those found with primaryperiampullary malignancies. An immunohistochemical portfolio including cytokeratin7/20 (CK7/20), homeobox protein CDX2,human epidermal growth factor receptor 2 (HER2/neu), estrogen receptor alfa (ERα), progesterone receptor (PgR),mammaglobin, gross cystic diseasefluid protein-15 (GCDFP-15), and transacting T-cell-specific transcription factor (GATA-3)was helpful for differential diagnosis among cases with ambiguous microscopic features.