182 Ahmed EL Hadi, et al. 2. Biopsies of the stomach showed 3. Treatment An adenocarcinoma of the stomach (Fig. 7) and a second opin- The breast tumour was treated with letrozole 2.5 mg daily as ion was sought with the Professor of Gastrointestinal histology who long term treatment. Surgical treatment was discussed with the concluded an adenocarcinoma of the stomach. The tumour was patient however she wanted to await the outcome of her stomach oestrogen receptor negative. The clinical TNM classification was cancer. Following that the patient then underwent a staging lapa- T2, N3, M0. roscopy followed by a subtotal D2 gastrectomy with roux en Y This was all discussed in the Multidisciplinary team meeting reconstruction. At laparotomy it was found that the antral ulcer had and it was that in evidence of oestrogen receptors being positive invaded the pancreas over a 2 cm wide area, after further intraop- in the breast tumour and negative in the stomach tumour that the erative consideration, the resection proceeded with excision of a patient most likely had two primary tumours. cuff of pancreatic tissue. She made a good postoperative recovery. Postoperatively the histology showed a large gastric ulcer with inflammation and fibrosis with NO evidence of malignancy. 22 lymph nodes were resected which were all negative for malignancy. Fig. 3. CT thorax showing an incidental finding of a left side breast tumour measuring 18.2 mm as demonstrated on the scan. CT = com- puterized tomography. Fig. 5. Left breast mammogram showing left side breast cancer. Fig. 4. CT thorax showing left axillary lymphadenopathy, one of the lymph node measured 11 mm as shown on the scan. CT = computer- ized tomography. Fig. 6. Left breast biopsy (Formalin fixed paraffin embedded tissue stained with haematoxylin-eosin) showing invasive ductal carcinoma of the breast grade 2.