Eric O. Then, MD1, Umair Shafiq Chishti, MD1, Andrew Ofosu, MD2, Vijay S. Are, MD3, Srikanth Maddika, MD1, Vinaya Gaduputi, MD, FACG4
1St. Barnabas Hospital, Bronx, NY; 2Brooklyn Hospital Center, Brooklyn, NY; 3Stormont Vail Health System, Topeka, KS; 4SBH Health System, Bronx, NY
Introduction: Breast cancer with metastasis involving the esophagus is a rare phenomenon. Most cases involve metastasis to the mediastinum resulting in esophageal compression. Less commonly these cases will metastasize directly to the mucosa or submucosa of the esophagus. Here we present a rare case of breast cancer metastasizing to the mucosal layer of the esophagus in addition to the mediastinum, resulting in esophageal compression.
Case Description/Methods: Patient is a 73 year old female with a medical history of left breast cancer with known metastasis to the lung, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hypothyroidism, and osteoporosis who presented to the emergency department complaining of worsening dysphagia for the past 3 months. She began having dysphagia to solids that slowly progressed to include liquids. Notable workup included a complete blood count with a hemoglobin of 10.9 gm/dL. The gastroenterology service was then consulted and performed an upper esophagagastroduodenoscopy which showed severe narrowing in the mid to lower esophagus with unhealthy appearing mucosa with contact oozing and desquamation. Multiple biopsies were taken from this area which returned showing metastatic carcinoma, consistent with breast primary. Immunohistochemical stains showed the neoplastic cells were positive for ER, and negative for p63, supporting the diagnosis. The patient then underwent PET scan which showed hypermetabolic posterior mediastinal lymphadenopathy causing extrinsic esophageal compression. During her admission the patient was able to tolerate pureed diet and was discharged to follow with oncology where she would undergo further treatment with Fulvestrant and Palbociclib.
Discussion: Breast metastases of mucosal and submucosal layers of the esophagus are extremely rare as esophageal involvement is usually secondary to mediastinal carcinosis. Diagnosis of breast cancer metastasizing to the esophagus is difficult as esophageal involvement can occur without clinical symptoms in a considerable number of patients with breast cancer. The most common clinical manifestations include dysphagia, accompanied by weight loss, anorexia and vocal dysfunction. Chemotherapy and hormonal therapy are the initial treatment of choice given that they significantly affect survival. Endoscopic placement of a stent should be reserved to those patients who do not have a significant improvement of dysphagia after treatment, or in cases of trachea-esophageal fistulas.
Citation: Eric O. Then, MD; Umair Shafiq Chishti, MD; Andrew Ofosu, MD; Vijay S. Are, MD; Srikanth Maddika, MD; Vinaya Gaduputi, MD, FACG. P0329 - MEDIASTINAL SYNDROME: A RARE ETIOLOGY OF DYSPHAGIA. Program No. P0329. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.