A Case of Invasive Lobular Carcinoma with Duodenal Stenosis Treated with Stenting

Abstract

An 81-year-old woman presented with vomiting. Her medical history included right breast cancer at the age of 67 years, for which she underwent total mastectomy and sentinel lymph node biopsy. She received adjuvant therapy with exemestane for five years. However, at the age of 80 years, during a routine health checkup, ultrasound examination showed right axillary lymph node enlargement. The result of biopsy was class IV, raising suspicion of breast cancer recurrence. PET/CT confirmed multiple lymph node and bone metastases.

As first-line treatment, she was started on a combination of letrozole and palbociclib. However, approximately seven months later, she presented to the emergency department with vomiting. Further evaluation showed duodenal stenosis. After a period of fasting and placement of a gastrostomy tube, a duodenal stent was inserted, allowing her to resume oral intake and subsequently be discharged. Two weeks after stent placement, she was readmitted due to recurrent vomiting caused by re-occlusion. The addition of a covered stent relieved the stenotic segment.

Treatment options for duodenal obstruction are gastrojejunostomy bypass and stent placement (with covered and uncovered types available). However, given the preterminal state associated with duodenal obstruction, careful consideration is essential when selecting the treatment approach.