True metastatic involvement of the colon is rare. Colonic metastases occur most commonly secondary to peritoneal metastases from intra-abdominal malignancies. Breast cancer is the most common malignancy that metastasizes hematogenously to the colon. Colonic metastatic disease mimics primary colonic tumors in its presentation. Colonic metastatic involvement is a poor prognostic sign, and the pathologist should be informed about the history of the primary breast cancer when examining the pathologic specimens. In this paper, we report a case of an ileocecal mass found to be histologically consistent with metastatic ductal breast cancer, and then we review the literature about breast cancer metastases to the gastrointestinal tract in general and colon in particular. 1. Introduction Metastatic involvement of the gastrointestinal (GI) tract is generally an infrequent clinical entity [1–3]. Colorectal involvement is particularly rare in the setting of metastatic diseases [4, 5] as opposed to small bowel, where metastatic disease is more common than primary malignancies [4]. Indeed, small bowel is the most common location of metastases within the GI tract, followed by the stomach [6, 7] owing to the rich vascular supply of these two locations [8]. Variability in the prevalence of metastatic involvement of these two common sites of metastasis is, however, observed with different primaries. Interestingly, in the setting of metastatic breast cancer, the stomach is the most frequent site within the GI tract for metastases and usually presents as linitis plastica [8–10]. Colonic metastases are much less common in the clinical setting of metastatic breast cancer. Metastatic involvement of the colon occurs most commonly secondary to peritoneal seeding from intra-abdominal malignancies. The most frequent location in which seeding occurs is in the pouch of Douglas [5, 11, 12]. Therefore, colonic involvement from surrounding intra-abdominal tumors (e.g., ovarian carcinoma) is much more common than hematogenous seeding [5]. Colorectal metastases can occur via various different pathways. Pelvic neoplasms can spread by direct invasion through the fasciae and mesenteric attachments or, more commonly, through the mesenteric reflections. The mesosigmoid and the right paracolic gutters are less commonly involved [11, 12]. Peritoneal carcinomatosis may arise from different locations: intra-abdominal primary tumors (e.g., mesothelioma) and intra-abdominal viscera (e.g., colon adenocarcinoma and ovarian carcinoma), or they may spread from extra-abdominal malignancies (e.g., breast
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