181 An Effect of Letrozole on Gastric Cancer? concluded that ERα expression can be reliably used to diagnose gastric metastasis of breast cancer. They also investigated if the expression pattern of E-cadherin could help in the differentiat- ing the diagnosis of primary gastric cancer versus metastatic breast carcinoma. In their study absence of E-cadherin staining was sig- nificantly related to metastatic breast carcinoma. Therefore absence of E-cadherin expression in an adenocarcinoma in a gastric biopsy should raise the possibility of metastatic breast carcinoma and ER α positivity can be reliably used to diagnose gastric metastasis of breast carcinoma. Positive monoclonal staining with gross cystic disease fluid protein-15 has been found to be a sensitive (55~76%) and specific (95~100%) marker to correctly identify a malignant lesion as meta- static breast carcinoma.(9-12) Table 1 summarizes the Immunohistochemical methods of Dif- ferentiating Primary gastric cancer from Metastatic gastric cancer. To summarize, in patients with a history of breast cancer, one should suspect the possibility of breast cancer metastasis to the stomach when new primary gastric cancer is diagnosed. Complete Table 1. To summarize the difference between primary stomach cancer and metastatic breast carcinoma of the stomach ERα E-cadherin GCDFP-15 Primary stomach cancer Negative Positive Negative Metastatic breast carcinoma of stomach Positive or negative Negative Positive ERα = oestrogen receptor α; GCDFP-15 = gross cystic disease fluid protein-15. histopathological and immunohistochemical analysis of the gastric biopsies and comparison with the original breast cancer pathology is important.(13) Case Report We present a 68 year old lady who was admitted as an emer- gency with malaise, weight loss & haemoglobin of 3 g/dl. She had not presented previously as she had been caring for her terminally ill husband .She underwent a gastroscopy to investigate her anae- mia which revealed a large size malignant appearing gastric ulcer at the antrum, this was biopsied and computerized tomography (CT) of the thorax and abdomen was requested. The CT Thorax and Abdomen scan showed thickening of the gastric antrum (Fig. 1) in additional to widespread lymphadenopa- thy in the greater omentum/mesentery (Fig. 2), the appearances were suggestive of gastric cancer. The CT scan also showed a co- incidental finding of a left breast cancer (Fig. 3) with left axillary lymphadenopathy (Fig. 4). On further questioning the patient had been aware of the breast lump for 18 months but did not seek medical advice. Following the CT she underwent a mammogram which confirmed the left side breast cancer (Fig. 5). 1. Biopsies of the left breast lump showed Invasive ductal carcinoma grade 2 (Fig. 6). The Clinical tumour node metastasis (TNM) classification was T2, N1, M0. The tumour cells are diffusely and strongly positive for oestro- gen receptors, negative for progesterone receptors, positive for E- cadherin which is consistent with an invasive ductal carcinoma and Herceptin 2 receptors positive. Fig. 1. CT abdomen showing thickening of the gastric antrum which measured approximately 19.3 mm. CT = computerized tomography. Fig. 2. CT abdomen demonstrates the mesenteric lymphadenopathy, showing two lymph nodes measuring 8.6 and 9.3 mm. CT = computer- ized tomography.