Omental cake - breast cancer metastases

Case contributed by Dra. Mónica Mariana Azor

Presentation

Patient with a history of breast cancer 15 years ago presented to the emergency with progressive dyspnea, bilateral edema of the lower limbs and abdominal "discomfort", such as a sensation of abdominal fullness of one month.

Patient Data

Age: 55 years
Gender: Female

Subphrenic nodular-like irregularities are observed. The omentum is heterogeneous, with areas of intermediate density that are enhanced with intravenous contrast. There is no fat separation plane with the right anterior wall of the abdomen (right anterior rectus muscle).

Liver with the appearance of dysmorphism due to chronic liver disease compatible with an increase in the caudate and a reduction in the size of the left lobe. Capsular retractions and macronodularity. Abundant ascites and collateral circulation with recanalization of the umbilical vein.

Case Discussion

Once admitted to the hospital, the patient provides the treating physicians with her previous studies and oncologic history, including a histological and immunohistochemical examination of biopsies from the ovary and peritoneum that demonstrate their relationship to previous breast pathology (multicentric infiltrating ductal carcinoma, stage IV, treated with chemotherapy) two years ago.
In this context, liver findings, ascites, and collateral circulation could be due to pseudocirrhosis.

Among the infrequent peritoneal involvement due to breast cancer, the high frequency of late-onset of metastases, together with the non-specificity of symptoms, is paradoxical.

Thanks Dra. Ariana Pesce for the participation. 

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