{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T11:39:06Z","timestamp":1782733146226,"version":"3.54.5"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T00:00:00Z","timestamp":1633651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Peritoneal metastases from invasive lobular carcinoma (ILC) of breast are uncommon and usually related to poor prognosis due to difficulty of detection in clinical practice and drug resistance. Therefore, recognizing the entities of peritoneal metastases of ILC and the potential mechanism of drug resistance is of great significance for early detection and providing accurate management. We herein report a case of a 60-year-old female who presented with nausea and vomiting as the first manifestation after treated with abemaciclib (a CDK4\/6 inhibitor) plus fulvestrant for 23 months due to bone metastasis of ILC. Exploratory laparotomy found multiple nodules in the peritoneum and omentum, and immunohistochemistry confirmed that the peritoneal metastatic lesions were consistent with ILC. Palliative therapy was initiated, but the patient died two months later due to disease progression with malignant ascites. Whole exome sequencing (WES) was used to detect the tumor samples and showed the peritoneal metastatic lesions had acquired ESR1 and PI3KCA mutations, potentially explaining the mechanism of endocrine therapy resistance. We argue that early diagnosis of peritoneal metastasis from breast cancer is crucial for prompt and adequate treatment and WES might be an effective supplementary technique for detection of potential gene mutations and providing accurate treatment for metastatic breast cancer patients.<\/jats:p>","DOI":"10.3389\/fendo.2021.659537","type":"journal-article","created":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T18:48:37Z","timestamp":1633891717000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Peritoneal Metastasis After Treated With Abemaciclib Plus Fulvestrant for Metastatic Invasive Lobular Breast Cancer: A Case Report and Review of the Literature"],"prefix":"10.3389","volume":"12","author":[{"given":"Hong-Fei","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Sheng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang-Zu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teng","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ci-Qiu","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu-Lu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie-Qing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Yi","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Niu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,10,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2015.09.033","article-title":"Comprehensive Molecular Portraits of Invasive Lobular Breast Cancer","volume":"163","author":"Ciriello","year":"2015","journal-title":"Cell"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.03.111","article-title":"Invasive Lobular Carcinoma Classic Type: Response to Primary Chemotherapy and Survival Outcomes","volume":"23","author":"Cristofanilli","year":"2005","journal-title":"J Clin Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2013.02.007","article-title":"Clinical-Pathologic Features, Long Term-Outcome and Surgical Treatment in a Large Series of Patients With Invasive Lobular Carcinoma (ILC) and Invasive Ductal Carcinoma (IDC)","volume":"39","author":"Biglia","year":"2013","journal-title":"Eur J Surg Oncol"},{"key":"B4","article-title":"Differential Loss of E-Cadherin Expression in Infiltrating Ductal and Lobular Breast Carcinomas","volume":"143","author":"Moll","year":"1993","journal-title":"Am J Pathol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"795","DOI":"10.2214\/ajr.175.3.1750795","article-title":"Metastatic Lobular Carcinoma of the Breast: Patterns of Spread in the Chest, Abdomen, and Pelvis on CT","volume":"175","author":"Winston","year":"2000","journal-title":"AJR Am J roentgenology"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1245\/ASO.2005.03.030","article-title":"Breast Cancer: Presentation and Intervention in Women With Gastrointestinal Metastasis and Carcinomatosis","volume":"12","author":"McLemore","year":"2005","journal-title":"Ann Surg Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2018-0363","article-title":"Mixed Invasive Ductal and Lobular Carcinoma of the Breast: Prognosis and the Importance of Histologic Grade","volume":"24","author":"Metzger-Filho","year":"2019","journal-title":"Oncologist"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.73.7585","article-title":"MONARCH 2: Abemaciclib in Combination With Fulvestrant in Women With HR+\/HER2- Advanced Breast Cancer Who Had Progressed While Receiving Endocrine Therapy","volume":"35","author":"Sledge","year":"2017","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1607303","article-title":"Palbociclib and Letrozole in Advanced Breast Cancer","volume":"375","author":"Finn","year":"2016","journal-title":"New Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00613-0","article-title":"Fulvestrant Plus Palbociclib Versus Fulvestrant Plus Placebo for Treatment of Hormone-Receptor-Positive, HER2-Negative Metastatic Breast Cancer That Progressed on Previous Endocrine Therapy (PALOMA-3): Final Analysis of the Multicentre, Double-Blind, Phase 3 Randomised Controlled Trial","volume":"17","author":"Cristofanilli","year":"2016","journal-title":"Lancet Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.75.6155","article-title":"MONARCH 3: Abemaciclib as Initial Therapy for Advanced Breast Cancer","volume":"35","author":"Goetz","year":"2017","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1609709","article-title":"Ribociclib as First-Line Therapy for HR-Positive, Advanced Breast Cancer","volume":"375","author":"Hortobagyi","year":"2016","journal-title":"New Engl J Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.78.9909","article-title":"Phase III Randomized Study of Ribociclib and Fulvestrant in Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer: MONALEESA-3","volume":"36","author":"Slamon","year":"2018","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2019.10.003","article-title":"Gastrointestinal Tract Metastasis Presenting as Intussusception in Invasive Lobular Carcinoma of the Breast: A Case Report","volume":"64","author":"Mosiun","year":"2019","journal-title":"Int J Surg Case Rep"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s12282-008-0045-0","article-title":"A Case of Recurrent Invasive Lobular Carcinoma of the Breast Found as Metastasis to the Duodenum","volume":"16","author":"Nihon-Yanagi","year":"2009","journal-title":"Breast Cancer (Tokyo Japan)"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1159\/000121003","article-title":"Occurrence of Synchronous Invasive Lobular Breast Carcinoma and Poorly Differentiated Ovarian Carcinoma in a Single Peritoneal Deposit","volume":"73","author":"Syed","year":"2007","journal-title":"Oncology"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.2325\/jbcs.14.333","article-title":"A Case of Metastatic Lobular Breast Carcinoma With Detection of the Primary Tumor After Ten Years","volume":"14","author":"Kobayashi","year":"2007","journal-title":"Breast Cancer (Tokyo Japan)"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2012.03.012","article-title":"An 81-Year-Old Patient With Distant Metastasis of Invasive Lobular Carcinoma Occurring 41 Years After Mastectomy","volume":"12","author":"Ademuyiwa","year":"2012","journal-title":"Clin Breast Cancer"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1186\/s13256-015-0568-x","article-title":"Metastatic Nonpalpable Invasive Lobular Breast Carcinoma Presenting as Rectal Stenosis: A Case Report","volume":"9","author":"Osaku","year":"2015","journal-title":"J Med Case Rep"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2004.07.057","article-title":"Unexpected Metastatic Lobular Carcinoma of the Breast With Intraabdominal Spread and Subsequent Port-Site Metastasis After Diagnostic Laparoscopy for Exclusion of Ovarian Cancer","volume":"95","author":"Mylonas","year":"2004","journal-title":"Gynecologic Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1177\/000313480607200518","article-title":"Gastric Metastasis 14 Years After Mastectomy for Breast Lobular Carcinoma: Case Report and Literature Review","volume":"72","author":"Aurello","year":"2006","journal-title":"Am surgeon"},{"key":"B22","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1002\/jso.2930480106","article-title":"Metastatic Pattern of Infiltrating Lobular Carcinoma of the Breast: An Autopsy Study","volume":"48","author":"Lamovec","year":"1991","journal-title":"J Surg Oncol"},{"key":"B23","article-title":"Metastatic Patterns of Invasive Lobular Versus Invasive Ductal Carcinoma of the Breast","volume":"114","author":"Borst","year":"1993","journal-title":"Surgery"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-017-1193-5","article-title":"Colonic Metastasis From Breast Carcinoma: A Case Report","volume":"15","author":"Tsujimura","year":"2017","journal-title":"World J Surg Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/986517","article-title":"Unusual Metastatic Patterns of Invasive Lobular Carcinoma of the Breast","volume":"2013","author":"Sobinsky","year":"2013","journal-title":"Case Rep oncological Med"},{"key":"B26","article-title":"Signet Ring Variant of Lobular Carcinoma of the Breast: A Clinicopathologic and Immunohistochemical Study","volume":"6","author":"Raju","year":"1993","journal-title":"Modern Pathol an Off J United States Can Acad Pathology Inc"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1177\/030089160509100509","article-title":"Single Colon Metastasis From Breast Cancer: A Clinical Case Report","volume":"91","author":"Signorelli","year":"2005","journal-title":"Tumori"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0463.2000.d01-84.x","article-title":"The Role of Cytokeratins 20 and 7 and Estrogen Receptor Analysis in Separation of Metastatic Lobular Carcinoma of the Breast and Metastatic Signet Ring Cell Carcinoma of the Gastrointestinal Tract","volume":"108","author":"Tot","year":"2000","journal-title":"APMIS Acta Pathologica Microbiologica Immunologica Scandinavica"},{"key":"B29","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1097\/PAS.0b013e3182a0218f","article-title":"GATA3: A Multispecific But Potentially Useful Marker in Surgical Pathology: A Systematic Analysis of 2500 Epithelial and Nonepithelial Tumors","volume":"38","author":"Miettinen","year":"2014","journal-title":"Am J Surg Pathol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-6-193","article-title":"Gastro-Intestinal Symptoms as Clinical Manifestation of Peritoneal and Retroperitoneal Spread of an Invasive Lobular Breast Cancer: Report of a Case and Review of the Literature","volume":"6","author":"Franceschini","year":"2006","journal-title":"BMC Cancer"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1159\/000348760","article-title":"Metastatic Breast Carcinoma Presenting as a Sigmoid Stricture: Report of a Case and Review of the Literature","volume":"7","author":"Nikkar-Esfahani","year":"2013","journal-title":"Case Rep Gastroenterol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/S12094-010-0481-0","article-title":"Rectal Metastasis From Lobular Breast Carcinoma 15 Years After Primary Diagnosis","volume":"12","author":"L\u00f3pez Deogracias","year":"2010","journal-title":"Clin Trans Oncol Off Publ Fed Spanish Oncol Societies Natl Cancer Institute Mexico"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-015-0703-6","article-title":"Cytoreduction and HIPEC in the Treatment of \u201cUnconventional\u201d Secondary Peritoneal Carcinomatosis","volume":"13","author":"Cardi","year":"2015","journal-title":"World J Surg Oncol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2013.02.020","article-title":"Treatment of Peritoneal Carcinomatosis From Breast Cancer by Maximal Cytoreduction and HIPEC: A Preliminary Report on 5 Cases","volume":"22","author":"Cardi","year":"2013","journal-title":"Breast (Edinburgh Scotland)"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1038\/sj.onc.1209482","article-title":"Intrinsic Focal Adhesion Kinase Activity Controls Orthotopic Breast Carcinoma Metastasis via the Regulation of Urokinase Plasminogen Activator Expression in a Syngeneic Tumor Model","volume":"25","author":"Mitra","year":"2006","journal-title":"Oncogene"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1242\/dmm.006395","article-title":"Mammary-Specific Inactivation of E-Cadherin and P53 Impairs Functional Gland Development and Leads to Pleomorphic Invasive Lobular Carcinoma in Mice","volume":"4","author":"Derksen","year":"2011","journal-title":"Dis Models Mech"},{"key":"B37","article-title":"E-Cadherin Is Inactivated in a Majority of Invasive Human Lobular Breast Cancers by Truncation Mutations Throughout Its Extracellular Domain","volume":"13","author":"Berx","year":"1996","journal-title":"Oncogene"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1158\/2159-8290.CD-18-0264","article-title":"The Genetic Landscape and Clonal Evolution of Breast Cancer Resistance to Palbociclib Plus Fulvestrant in the PALOMA-3 Trial","volume":"8","author":"O'Leary","year":"2018","journal-title":"Cancer Discovery"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32345","article-title":"ESR1 Mutations in Breast Cancer","volume":"125","author":"Dustin","year":"2019","journal-title":"Cancer"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-016-3829-5","article-title":"ESR1 Mutations Affect Anti-Proliferative Responses to Tamoxifen Through Enhanced Cross-Talk With IGF Signaling","volume":"157","author":"Gelsomino","year":"2016","journal-title":"Breast Cancer Res Treat"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1038\/ng.2823","article-title":"Activating ESR1 Mutations in Hormone-Resistant Metastatic Breast Cancer","volume":"45","author":"Robinson","year":"2013","journal-title":"Nat Genet"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.67.3061","article-title":"Plasma ESR1 Mutations and the Treatment of Estrogen Receptor-Positive Advanced Breast Cancer","volume":"34","author":"Fribbens","year":"2016","journal-title":"J Clin Oncol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.1279","article-title":"Prevalence of ESR1 Mutations in Cell-Free DNA and Outcomes in Metastatic Breast Cancer: A Secondary Analysis of the BOLERO-2 Clinical Trial","volume":"2","author":"Chandarlapaty","year":"2016","journal-title":"JAMA Oncol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-15-0728","article-title":"Early Adaptation and Acquired Resistance to CDK4\/6 Inhibition in Estrogen Receptor-Positive Breast Cancer","volume":"76","author":"Herrera-Abreu","year":"2016","journal-title":"Cancer Res"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-16-2653","article-title":"Kinome-Wide RNA Interference Screen Reveals a Role for PDK1 in Acquired Resistance to CDK4\/6 Inhibition in ER-Positive Breast Cancer","volume":"77","author":"Jansen","year":"2017","journal-title":"Cancer Res"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1813904","article-title":"Alpelisib for PIK3CA-Mutated, Hormone Receptor-Positive Advanced Breast Cancer","volume":"380","author":"Andr\u00e9","year":"2019","journal-title":"N Engl J Med"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1158\/1538-7445.SABCS18-GS3-08","article-title":"Alpelisib + Fulvestrant for Advanced Breast Cancer: Subgroup Analyses From the Phase III SOLAR-1 Trial","author":"Juric D","year":"2019","journal-title":"Cancer Res"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.659537\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T18:48:41Z","timestamp":1633891721000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.659537\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,8]]},"references-count":47,"alternative-id":["10.3389\/fendo.2021.659537"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2021.659537","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,8]]},"article-number":"659537"}}