Abstract
IntroductionCases of esophageal metastasis of breast cancer are extremely rare. We present the case of a patient who developed recurrence as esophageal metastasis following treatment of bilateral breast cancer. Early-stage gastric cancer was also found coincidentally.Case presentationAn 86-year-old Japanese female patient with a history of bilateral breast cancer was found to have a gastric mass on a medical examination. At 72 years of age, she had undergone a total mastectomy with level II axillary lymph node dissection (pT3N0M0 stage II). Left breast cancer was found at the age of 79. A total mastectomy was performed with level II axillary lymph node dissection (pT1N0M0 stage I). At the time of her current admission, our patient complained of dysphagia. A repeat gastrofiberscopy revealed a submucosal lesion in her middle esophagus, located 27cm distal to her incisors, as well as a known type I tumor of the gastric cardia. Computed tomography showed a mass lesion in her middle esophagus that had grown extraluminally and infiltrated the tracheal bifurcation and her left primary bronchus. A boring biopsy of the esophageal lesion was performed under ultrasonic monitoring, and a pathological diagnosis of poorly differentiated adenocarcinoma of the esophagus was obtained. The biopsy of the cardiac lesion revealed moderately differentiated adenocarcinoma of the stomach. The expression status of her hormone receptors indicated that the esophageal lesion reflected metastatic recurrence of her breast cancer with coincidental primary gastric cancer (cT1N0M0 stage IA).ConclusionsEsophageal metastasis of breast cancer is extremely rare. An individualized treatment plan combining multimodal approaches should therefore be devised according to the patient’s status.
Highlights
Cases of esophageal metastasis of breast cancer are extremely rare
Distant metastasis from primary breast cancer often occurs in the bones, lungs and liver
We present the case of a patient who developed recurrence as esophageal metastasis following treatment of bilateral breast cancer
Summary
Distant metastasis from primary breast cancer often occurs in the bones, lungs and liver. The administration of chemotherapy and endocrine therapy for her breast cancer was prioritized because the esophageal lesion of the breast cancer was much more advanced and critical for our patient’s status than the gastric cancer She received metronomic medication with daily oral administration of tegafur-uracil (400mg per kilogram body weight), cyclophosphamide (100mg/day) and medroxyprogesterone acetate (800mg/ day) based on her age and therapeutic history, as well as the biological subtype of the tumor and presence of the non-treated gastric cancer. She has since maintained a good performance status on outpatient treatment with chemo-endocrine therapy, and no disease progression had been noted to date, six months after the radiation therapy
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