Abstract
BackgroundEsophageal involvement and Horner’s syndrome are rare manifestations of breast cancer distant metastases that can pose a significant challenge in diagnosis and treatment. In addition to the more aggressive behavior of breast cancer diagnosed in young women, non-adherence to treatment is associated with increased risk of distant metastasis.Case presentationA 36-year-old Javanese woman presented to our institution with dysphagia, hoarseness, and frequent hiccups. In the 6 weeks prior to the current admission, the patient also reported tingling in the neck and shoulder, anhidrosis in the left hemifacial region, and drooping of the upper left eyelid. She was previously managed as tuberculoid laryngitis. Plain X-rays showed burst fractures of the cervical vertebrae and slight pleural effusion. Laryngoscopy revealed bowing of the vocal cords and liquid residue in the vallecula that was reduced upon chin tuck. Esophageal metastasis was confirmed with endoscopy showing thickening of the wall and positive cytology swab with ductal malignant cells. The patient had a history of breast cancer with a period of loss to follow-up of 4 years.ConclusionsPhysicians should consider potential distant metastasis of breast cancer to the esophagus and sympathetic nervous system of the neck particularly in a high-risk woman with presentation of dysphagia and manifestations of Horner’s syndrome.
Highlights
Esophageal involvement and Horner’s syndrome are rare manifestations of breast cancer distant metastases that can pose a significant challenge in diagnosis and treatment
Approximately 30% of patients with breast cancer will eventually develop distant metastasis including those who are diagnosed in early stages [1]
We report dual presentations of esophageal infiltration and Horner’s syndrome as clinical manifestations of breast cancer metastases that have not been previously reported
Summary
The co-occurrence of esophageal spread and Horner’s syndrome in a young woman with breast cancer is very rare and, to our knowledge, has never been reported previously. Diagnosis, and treatment workups are very challenging, in a patient with low or non-adherence to cancer treatment. Systemic treatment remains the most preferred option for esophageal metastasis, in a patient with other synchronous metastatic sites
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