What happened, in summary

An 84-year-old woman presented with 6 months of intermittent difficulty swallowing, early fullness after eating and weight loss. Eight years after an earlier ductal breast cancer, she had developed a separate invasive lobular carcinoma in the left breast. The lobular tumour was oestrogen- and progesterone-receptor positive and HER2 negative. It was treated with radical mastectomy and axillary lymph-node dissection, followed by 5 years of tamoxifen. At the new presentation, endoscopy identified oesophageal strictures that helped explain the swallowing difficulty. The stomach did not contain a distinct mass, but its folds were thickened and red. Biopsies taken from the gastric lining unexpectedly showed adenocarcinoma. Tumour cells were positive for mammaglobin, GATA3 and oestrogen receptor, with patchy GCDFP-15 staining, supporting metastatic lobular breast cancer rather than a new gastric cancer. Repeated dilation and stenting were used to manage the oesophageal stricture, but her oral intake and overall condition continued to worsen. Repeat CT later showed additional metastases involving bone, the neck and the mediastinum. She chose palliative care for the remainder of her illness and died 7 months after the endoscopy that identified gastric involvement.