Metastatic Breast Cancer Mimicking Barrettʼs Esophagus: A Case Report

Abstract

Breast cancer is one of the most common malignancies observed across the globe. Metastases in advanced stages are most commonly seen in lungs, bone, brain and liver. However, luminal infiltration of the metastatic malignant cells in the esophagus and stomach is extremely uncommon. We describe an unusual presentation of the esophageal infiltration by malignant cells causing symptoms of reflux gastropathy, endoscopic appearance resembling Barrett's esophagus without evidence of metastatic disease on PET CT scan imaging. A 63-year-old woman with a history of Stage II breast cancer treated with bilateral mastectomy and chemotherapy 14 years ago, presented with the complaint of recent development of post-prandial epigastric pain and occasional heartburn. Her follow up PET CT Scan was negative for any metastatic disease. EGD showed Barrett's appearing esophageal mucosa 1 cm above the gastro-esophageal junction (GEJ) circumferentially with a 2 cm maximum extension above GEJ. A 7 mm x 10 mm nodule was also noted just above the GEJ [Figure 1]. They were removed using band ligation endoscopic mucosal resection kit. The histopathologic examination of the nodule showed poorly differentiated adenocarcinoma, 6 mm in greatest diameter involving the muscularis mucosa [Figure 2A]. The immunohistochemistry (IHC) was positive for estrogen receptor (alpha) [Figure 2B] and gross cystic disease fluid protein -15 (GCDFP -15) [Figure 2C], negative for progesterone receptor and Her2 by immunoperoxidase staining. Random biopsies obtained from the gastric antrum and pylorus also showed poorly differentiated malignant cells.Two months later, a salmon colored mucosa extending from 34cm to 35cm of esophagus was found on follow-up EGD. It was ablated using HALO-90 Radio-frequency ablation (RFA) circumferentially. The patient was asymptomatic on a follow-up visit and has been taking a proton pump inhibitor daily. She was scheduled for a surveillance endoscopy 6-8 weeks later. Although rare, breast cancer metastasis to the lumen of the gut can present as common gastrointestinal symptoms like dysphagia, obstruction and rarely reflux. The most commonly involved organs are the stomach (10%), small intestine (9%) and large intestine (8%). This case stresses on the importance of an extensive workup of newly developed gastrointestinal symptoms in a patient with a history of breast cancer, regardless of the duration from the initial diagnosis.Figure 1Figure 2