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Balázs Á, Vass T, Baranyai Z. Esophageal Strictures due to Mediastinal Metastases from Breast Cancer. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03369-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AbstractMediastinal metastases represent an infrequent recurrence of breast carcinoma. Esophageal involvement by metastatic tissue is extremely rare. The situation means an unusual diagnostic and therapeutic challenge. Dignity of esophageal stricture is difficult to ascertain; endoscopy and picture giving methods might be conflicting. This study aimed to analyze the clinical characteristics and the therapeutic possibilities of the condition. A retrospective analysis of malignant esophageal stricture cases was performed from a prospectively collected database between 1984 and 2020. Out of 3996 cases with esophageal malignancy, 17 esophageal strictures were confirmed to be related to breast cancer metastasis. Surgical resection was feasible in 3 cases; endoprosthesis insertion was performed for palliation in 7 cases, and in 7 cases, only supportive care was available. Our incidence rate was 0.43%. Dysphagia indicating an affected esophagus presented on average 10.5 years after the primary tumor surgery. Mean duration between onset of symptoms achieving appropriate diagnosis was 6.4 months. Dignity of the malignancy was confirmed only retrospectively in one case. Morphologic findings showed an external esophageal compression in 52.9%, while in 35.3%, a destructive tumor growth affecting the mucosal layer could be found. Overall, survival was 7.6 months referring to 15 cases. The possible occurrence of mediastinal metastases involving the esophagus should be seriously considered in patients with previous breast cancer history. Biopsies obtained from the intact mucosal surface of the stenotic esophagus are often inefficient and misleading; therefore, repeated biopsies are necessary. Options for radical surgery are highly limited.
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Miyake M, Yamada A, Miyake K, Endo I. Esophageal metastasis of breast cancer during endocrine therapy for pleural dissemination 21 years after breast surgery: a case report. Surg Case Rep 2019; 5:22. [PMID: 30771195 PMCID: PMC6377688 DOI: 10.1186/s40792-019-0585-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/06/2019] [Indexed: 12/19/2022] Open
Abstract
Background The esophageal metastasis of breast cancer is rare. Moreover, it is extremely unusual for patients to experience the symptoms of esophageal metastasis during their lifetimes. We present a case of dysphagia caused by esophageal metastasis after a long interval following a primary mastectomy. Case presentation A 77-year-old woman with a history of heterochronous bilateral breast cancer and under treatment for pleural dissemination recurrence originating from right breast cancer complained of dysphagia. At the age of 56, she had undergone a right radical mastectomy for right breast cancer. The histopathological findings revealed invasive ductal carcinoma, pT3N1M0, which was estrogen receptor (ER)- and progesterone receptor (PgR)-positive. At the age of 73, she underwent a second operation, a left modified radical mastectomy. The histopathological examination revealed invasive ductal carcinoma, pT1N0M0, which was negative for ER, PgR, and human epidermal growth factor receptor 2 (HER2). Four years after completion of adjuvant therapy for the left breast cancer, pleural effusion on her left side was observed and histopathological examination of a sample revealed pleural dissemination resulting from the right breast cancer. After initiation of therapy for recurrence, she developed dysphagia and, therefore, underwent an upper gastrointestinal tract endoscopic examination. The examination revealed whole circumferential stenosis and a band unstained by Lugol’s solution located 30 cm from her incisors. Examination of a biopsy specimen revealed a subepithelial luminal structure and dysplastic cells. Immunostaining was positive for CK7 and negative for CK20; furthermore, the sample was ER and PgR-positive. Considering the pathological findings, the patient was diagnosed with esophageal metastasis of her right breast cancer. Conclusions Metastatic lesions in the esophagus are often located in the submucosa; therefore, they may not be definitively diagnosed by histopathological examination of mucosal biopsy specimens. Esophageal metastasis originating from breast cancer often occurs as a part of multiple organ metastases; however, esophageal metastasis is usually not considered a prognostic factor for patients. Therefore, treatment should be determined according to the severity of the other metastatic sites and the degree of esophageal stenosis.
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Affiliation(s)
- Masuyo Miyake
- Department of Breast Surgery, Chigasaki Municipal Hospital, Honson 3-5-1, Chigasaki, Kanagawa, 253-0042, Japan.,Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Fukuura 3-9, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
| | - Akimitsu Yamada
- Department of Breast Surgery, Chigasaki Municipal Hospital, Honson 3-5-1, Chigasaki, Kanagawa, 253-0042, Japan. .,Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Fukuura 3-9, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan.
| | - Kentaro Miyake
- Department of Breast Surgery, Chigasaki Municipal Hospital, Honson 3-5-1, Chigasaki, Kanagawa, 253-0042, Japan.,Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Fukuura 3-9, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Fukuura 3-9, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
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Liu A, Feng Y, Chen B, Li L, Wu D, Qian J, Yang A. A case report of metastatic breast cancer initially presenting with esophageal dysphagia. Medicine (Baltimore) 2018; 97:e13184. [PMID: 30407355 PMCID: PMC6250498 DOI: 10.1097/md.0000000000013184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Breast cancer metastasis to the esophagus is uncommon. To our knowledge, the present case is the first report of breast cancer with dysphagia as the initial symptom. PATIENT CONCERNS A 62-year-old woman was admitted to our hospital for progressive dysphagia. DIAGNOSES Endoscopic ultrasound-guided fine needle biopsy of the esophageal lesion found poorly differentiated carcinoma, and surgical resection of the breast nodule revealed invasive ductal carcinoma. INTERVENTIONS The patient underwent an esophagectomy, and the immunohistochemistry of surgical specimen was identified as metastatic breast cancer. Then patient was treated with chemotherapy and hormone therapy. OUTCOMES The patient remained symptom-free during 5 months of follow-up examinations. LESSONS This case indicates that metastatic breast cancer to the esophagus should be considered as a cause of esophageal stricture in older women.
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Affiliation(s)
| | | | | | - Li Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zanghì S, Siboni S, Asti E, Festa A, Bonavina L. Metastasis to the esophagus from primary adenocarcinoma of the lung. Eur Surg 2017. [DOI: 10.1007/s10353-017-0501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Breast cancer recurrence in esophagus, stomach, and liver, 15 years following primary surgery: report of a case. Int Cancer Conf J 2015. [DOI: 10.1007/s13691-014-0193-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kashiwagi S, Onoda N, Asano Y, Noda S, Kawajiri H, Takashima T, Ishikawa T, Hirakawa K. A rare recurrence of bilateral breast cancer in the esophagus coincidentally associated with primary gastric cancer: a case report. J Med Case Rep 2014; 8:58. [PMID: 24533645 PMCID: PMC3930013 DOI: 10.1186/1752-1947-8-58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 12/23/2013] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Cases 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 PRESENTATION An 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). CONCLUSIONS Esophageal metastasis of breast cancer is extremely rare. An individualized treatment plan combining multimodal approaches should therefore be devised according to the patient's status.
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Affiliation(s)
- Shinichiro Kashiwagi
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Naoyoshi Onoda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Yuka Asano
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Satoru Noda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Hidemi Kawajiri
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Tsutomu Takashima
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Tetsuro Ishikawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
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Wada Y, Harada N, Ohara K, Kawata H, Iwasaki H, Kawamura Y, Gomi T, Ohtoshi M, Nakashima Y. Esophageal metastasis of breast carcinoma. Breast Cancer 2008; 16:151-6. [PMID: 18762863 DOI: 10.1007/s12282-008-0068-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Accepted: 07/22/2008] [Indexed: 01/27/2023]
Abstract
Esophageal metastasis from primary breast cancer is an unusual manifestation. We recently treated a patient with dysphagia, whose breast cancer had been treated in the distant past. A 70-year-old woman had been followed regularly in our outpatient clinic for 14 years after her primary breast cancer treatment, with no apparent tumor recurrence. After 2 years absence, she consulted our clinic with progressive dysphagia. Contrast esophagography and endoscopic examination with ultrasonography revealed a protruding submucosal tumor that was histopathologically diagnosed as esophageal metastasis of breast cancer. Radiation therapy involving a total of 60 Gy in combination with aromatase inhibitor was given. The patient's dysphagia was greatly relieved, concomitant with marked improvement of the stenotic lesion on imaging. Since treatment for recurrent breast cancer is generally palliative, systemic (chemo- and/or endocrine-) therapy in combination with radiotherapy is the first-line option for esophageal metastasis of breast cancer.
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Affiliation(s)
- Yasuo Wada
- Department of Surgery, NHO Himeji Medical Center, 68 Honmachi, Himeji, Hyogo, 670-8520, Japan.
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Kovács O, Kotsis L, Krasznai G. [Solitary oesophageal metastasis of breast cancer after 17 years latency]. Magy Seb 2007; 60:307-9. [PMID: 18065370 DOI: 10.1556/maseb.60.2007.6.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors discuss a case of a 63-year-old woman, who presented with dysphagia, 17 years after radical mastectomy for breast cancer. CT scan showed a juxta esophageal mediastinal tumour. A biopsy via right thoracotomy revealed a metastatic adenocarcinoma of the oesophageal wall from the previous breast carcinoma. Minimally invasive oesophageal intubation was used for palliation. Hormonal manipulation and radiotherapy was commenced postoperatively. The patient was well after eight months follow-up. A combination of high clinical suspicion with EUS and deep oesophageal biopsy can lead to the correct diagnosis of this very rare clinical entity. The biology of metastatic breast cancer may demand palliation by oesophageal intubation or stenting combined with adjuvant chemo, radio or hormonal therapy in such instances.
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Rampado S, Ruol A, Guido M, Zaninotto G, Battaglia G, Costantini M, Portale G, Amico A, Ancona E. Mediastinal carcinosis involving the esophagus in breast cancer: the "breast-esophagus" syndrome: report on 25 cases and guidelines for diagnosis and treatment. Ann Surg 2007; 246:316-22. [PMID: 17667512 PMCID: PMC1933553 DOI: 10.1097/01.sla.0000263507.11053.26] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Breast metastases of mucosal/submucosal layers of the esophagus are extremely rare: esophageal involvement is usually part of a mediastinal carcinosis. AIM We report the largest series to date of 25 cases of metastatic esophageal involvement from breast cancer, discussing both diagnostic techniques and treatment options. MATERIALS AND METHODS Twenty-five female patients with a history of breast cancer referred for secondary esophageal involvement (1980-2006) were studied. RESULTS All patients presented with worsening dysphagia. Twenty-four had undergone surgery for breast cancer a median of 10 years earlier: 1 had received chemoradiotherapy, and 17 had adjuvant radiotherapy/telecobalt therapy following breast surgery. Endoscopic biopsy/cytology were negative for cancer in 17 of 19 patients; in 9 patients, the diagnosis was made with thoracoscopy/laparoscopy. Immunohistochemical staining was done in 10 patients (ER and/or PrR positive). Fifteen patients presented with distant metastatic involvement. Therapy was directed toward dysphagia relief, mostly with endoscopic dilations/prostheses. Complications (4 perforations) occurred only in those 15 patients who had endoscopic dilations/prostheses. Fifteen patients had cytoreductive therapy. Nine of 25 patients are still alive. The median overall survival was 7 months; 1-, 3-, and 5-year survival rates were 44%, 16%, and 8%, respectively. CONCLUSIONS A "breast-esophagus" syndrome can be defined: it is often diagnosed only after excluding other diseases or after relief of dysphagia with adequate therapy. The presence of distant metastases helps the diagnosis of esophageal involvement from mediastinal carcinosis, while diagnosis is a problem in case of mediastinal/pleural disease only: in this case, exploratory thoracoscopy is mandatory for a final diagnosis. Given the high related risk of perforation from endoscopic procedures (dilations/prostheses), the treatments of choice are currently hormone therapy or chemotherapy/radiotherapy.
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Anaya DA, Yu M, Karmy-Jones R. Esophageal perforation in a patient with metastatic breast cancer to esophagus. Ann Thorac Surg 2006; 81:1136-8. [PMID: 16488749 DOI: 10.1016/j.athoracsur.2005.01.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 01/04/2005] [Accepted: 01/18/2005] [Indexed: 11/20/2022]
Abstract
Esophageal metastasis from breast cancer is rare and can present after a long latency period. The middle and distal third of the esophagus are the most common sites and dysphagia (with or without stricture) is the most common presentation. Because of predominantly submucosal involvement, diagnosis is often difficult to establish until significant complications arise. We present the case of a patient with esophageal perforation due to dilatation treatments for dysphagia secondary to a distal stricture, later proven to be caused by esophageal metastasis from a breast cancer treated 19 years earlier.
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Affiliation(s)
- Daniel A Anaya
- Division of Thoracic and Trauma Surgery, Harborview Medical Center, University of Washington, Seattle, Washington 98104-2499, USA
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Akcali Z, Sakalli H, Ozyilkan O, Demirhan B, Haberal M. Prognostically Favorable Abdominal Breast Cancer Metastases with Stomach Involvement. Oncol Res Treat 2005; 28:270-2. [PMID: 15867484 DOI: 10.1159/000084652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Abdominal metastases with stomach involvement are rare in breast cancer. The median disease free interval from the time of breast cancer diagnosis to gastric metastasis is usually very long. Treatment is generally palliative, and expected survival time is less than 1 year. CASE REPORT A 59-year-old woman with breast cancer developed diffuse abdominal metastases involving stomach, abdominal lymph nodes, and omentum 9 years after she underwent mastectomy and adjuvant chemotherapy. The histopathologic diagnosis found by stomach specimen examination was invasive lobular carcinoma, and the cells expressed high levels of estrogen and progesterone receptors. The abdominal metastases were treated with surgery, postoperative chemotherapy, and further hormonal therapy. This was successful, and the patient has been in remission for more than 3 years. CONCLUSION Once the definitive diagnosis of breast cancer metastases to the abdomen including the stomach is established, treatment that targets systemic breast cancer must be initiated. Our patient's extended survival time suggests that surgical treatment could be considered for selected patients.
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Affiliation(s)
- Zafer Akcali
- Department of Medical Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.
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LeBlanc J, Youssef W, DeWitt J, Sherman S, Chappo J, McHenry L. Metastatic breast cancer to the gastroesophageal junction 14 years after radical mastectomy. Gastrointest Endosc 2004; 59:733-6. [PMID: 15114327 DOI: 10.1016/s0016-5107(04)00293-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Julia LeBlanc
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
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