Metastasis of lobular breast carcinoma diagnosed by rectal macrobiopsies.

We present the case of a 72-year-old woman with invasive lobular breast carcinoma, stage IV (vertebral metastasis), and with recent-onset constipation. Digital rectal examination revealed increased consistency of the rectal wall. Laboratory test showed only elevation of CEA-II (28'3). Rectoscopy showed a partial stenosis of the rectal lumen, extending from the internal anal margin to about 10 cm, with irregular and micronodular mucosa and clearly decreased rectal wall distensibility simulating linitis plastica (Fig. 1A). Biopsy revealed only chronic inflammatory changes. Endoscopic ultrasonography identified a diffuse thickening of the rectal wall, up to 13 mm, with loss of normal echostructure. Further biopsies and fine-needle aspiration (22G) were performed without showing either the existence of atypical cells. Given the high suspicion of rectal metastatic disease, macrobiopsies with polipectomy snare were taken (Fig. 1B). Final histological diagnosis was metastatic carcinoma of the breast (stained positively for cytokeratin AE1, AE3, cytokeratin 19, mammaglobin, GCDFP-15 and estrogen receptors).