previously with fibrocystic disease of the breast (benign) and had had a number of cyst aspirations. Scanty curettings were received, and histological examination revealed fragments of endometrium containing scattered inactive glands. The stroma was expanded and replaced largely by diffuse sheets of malignant cells, including signet ring forms. The pattern of stromal infiltration, with preservation of the glands, was characteristic of metastatic adenocarcinoma (Zaino, 1996). Immunocytochemistry revealed positivity of the tumour cells for cytokertain 7(CK7) and negativity for oestrogen receptor, cytokeratin 20, carcinoembryonic antigen and CA125. Because of the CK7 positivity and the presence of signet ring cells, a gastric primary was considered. Upper gastrointestinal endoscopy was unremarkable. A gastric biopsy showed mild inflammatory changes only. Mammography subsequently suggested an abnormality in the left breast and core biopsy of the left breast confirmed the presence of invasive lobular carcinoma with focal lobular carcinoma in situ. The tumour cells had a similar morphology and immunoprofile to those seen in the endometrium. Further investigation included chest radiography, ultrasound examination of the pelvis, computerised tomography (CT) of chest, abdomen and pelvis in addition to full blood count and routine biochemistry. A bone scan was carried out. These investigations were all normal.
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