Case Reports in Medicine esophagus (25%), stomach (25%), small intestine (28%), colon (19%), and rectum (4%) [5]. Cormier et al. [9] reported six patients with linitis plastica attributable to metastatic breast cancer. All six cases were associated with lobular breast carcinoma. A 30-year review by the same group revealed 25 additional cases in which lobular carcinoma and linitis plastica due to metastasis occurred metachronously or synchronously in patients. Most of the women (74%) had metastasis within 5 years of the initial diagnosis of breast cancer; however, four patients presented with metastatic gastric disease more than 10 years after the identiﬁcation of the primary breast cancer [9]. McLemore et al. [10] found that 73 patients out of 12,001 with metastatic disease secondary to breast cancer had GI tract involvement. The mean interval between primary breast cancers to GI presentation was 7 years. However, 16% of patients were found to have peritoneal metastatic disease at the time of their breast cancer diagnosis. Abdominal pain was found to be the most common symptom of breast cancer metastatic to the gastrointestinal tract, followed by bloating, melena, GI hemorrhage, bowel obstruction, early satiety, dysphagia, weight loss, anemia, fatigue, and a palpable abdominal mass [10]. Metastatic breast cancer can easily be mistaken for a primary gastrointestinal cancer [11, 12]. Schwartz et al. [11] found that seven patients who presented with gastrointesti- nal symptoms were initially thought to have primary GI cancer, one with a nearly obstructing colon tumor. These patients were found to have primary breast cancer after subsequent comparisons with prior breast specimens. Metastatic breast cancer can be diﬃcult to distinguish from primary gastric cancer. Metastasis to the stomach from lobular type carcinoma tends to exhibit tumor cells that are inﬁltrating in single ﬁle process between benign gastric glands. Signet cells may be occasionally noted. This histologic ﬁnding resembles primary diﬀuse type gastric carcinomas (linitis plastica). Metastasis from ductal type carcinoma can resemble poorly diﬀerentiated intestinal type gastric adenocarcinomas [11]. Immunohistochemical markers for estrogen receptor and diﬀerential cytokeratin expression (cytokeratin 7 and cytokeratin 20) can allow accurate diagnosis. It is important to make the distinction between a primary or a metastatic breast carcinoma. The administration of chemotherapy and hormonal therapy can signiﬁcantly improve the survival in patients with metastatic breast carcinoma [9, 10]. There is a palliative role for surgery for the relief of symptoms such as pain from mass eﬀect, obstruction, or dysphagia. In general, gastric metastases from breast cancer reﬂect a poor prognosis despite chemotherapy and hormonal therapy. Median survival time from the time of diagnosis of metastases was noted to be approximately 28 months [10]. 5. Conclusion It is important for physicians who follow survivors of invasive lobular carcinoma of the breast to remember that gastrointestinal symptoms can be a manifestation of 3 metastatic disease. The disease free interval between primary breast cancer and gastrointestinal involvement may be as long as 10 years from the time of diagnosis. In our unique case, the breast primary was not found. Once the correct diagnosis is made, targeted systemic treatment speciﬁc for breast cancer may be considered and initiated if appropriate. References [1] B. G. Taal, H. Peterse, and H. Boot, “Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma,” Cancer, vol. 89, no. 11, pp. 2214–2221, 2000. [2] R. Varadarajan, S. B. Edge, J. 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