case_images: PMC3262580_01
case_images: CT scan shows small bowel dilatation, no other specific features.
case_images: IJBC2011-413949.001.jpg
case_images: PMC3262580_01_IJBC2011-413949.001.jpg
case_images: fig1
case_images: A CT scan showed evidence of small bowel obstruction (Figure 1); a laparotomy and resection of a thickened and narrowed terminal ileum were carried out followed by bowel anastomosis.
case_images: CT scan reveals left hydronephrosis secondary to compression on lower ureter by a rectal mass, previous right nephrectomy.
case_images: IJBC2011-413949.002.jpg
case_images: PMC3262580_01_IJBC2011-413949.002.jpg
case_images: fig2
case_images: Staging CT scan identified left hydronephrosis caused by compression on the ureter from the metastasis in the rectum (Figure 2).
case_images: View at sigmoidoscopy showing narrowed lumen, which was felt to be due to a firm and swollen mucosa by the endoscopist.
case_images: IJBC2011-413949.003.jpg
case_images: PMC3262580_01_IJBC2011-413949.003.jpg
case_images: fig3
case_images: Unfortunately, 3 months later, the patient had new episodes of diarrhoea with fresh blood; sigmoidoscopy showed a narrowed lumen and firm swollen mucosa at the upper rectum (Figure 3); biopsies revealed the presence of metastatic lobular carcinoma of breast, the tumour foci stained positive with cytokeratin 7 (CK7), pancytokeratins, and ER.
case_images: Small bowel mucosa infiltrated by cords of metastatic lobular adenocarcinoma cells. (Haematoxylin and eosin, original magnification x400.)
case_images: IJBC2011-413949.004.jpg
case_images: PMC3262580_01_IJBC2011-413949.004.jpg
case_images: fig4
case_images: The histological analysis confirmed the presence of widely infiltrated small bowel by well-differentiated epithelial cells, some of which contained intracytoplasmic lumina and formed a single file pattern of infiltration (Figure 4).
case_images: The same slide stained with antibody to estrogen receptor. The malignant cells stain brown (ER clone 6F11, original magnification x400).
case_images: IJBC2011-413949.005.jpg
case_images: PMC3262580_01_IJBC2011-413949.005.jpg
case_images: fig5
case_images: The appearances were those of metastatic lobular carcinoma of breast, which was ER positive and E-cadherin & Her 2 negative (Figure 5), invaded the mucosa, the mesentery, and appeared to extend beyond the mesenteric margins of excision.