Carolinas Healthcare System - Blue Ridge Morganton, NC
Rachael Weigle, DO, MPH1, Charles Carver, DO1, Suneel Mohammed, MD1, Gerald Mank, MD2; 1Carolinas Healthcare System - Blue Ridge, Morganton, NC; 2Blue Ridge Digestive Health, Morganton, NC
Introduction: Breast cancer is the second most diagnosed malignancy in the United States and is the leading cause of cancer death in women worldwide. It has a prolonged course and has the potential for systemic metastasis over a lifetime. The most common sites of metastatic involvement are bone, liver, and lungs. Breast cancer metastasis to the esophagus is an extremely rare occurrence. Below, we present a case of breast cancer metastases to esophagus, found during esophageal dilatation in the setting of food impaction.
Methods: A 70-year-old woman was admitted to our hospital with progressive symptoms of dysphagia to solid foods lasting several weeks and associated regurgitation for several days. Patient had a history of Stage IIIB ER+ Ductal breast carcinoma s/p left mastectomy with axillary node dissection, pectoralis muscle removal, and chemoradiation from 2012-2013. She was maintained on hormone therapy and had yearly follow ups with oncology with multiple repeat PET/CT without reoccurrence observed. At time of hospitalization, patient underwent same day EGD with removal of food impaction at middle third of esophagus. Dilatation with balloon dilator 8-9-10mm was then performed up to 10mm due to severe intrinsic stenosis observed measuring a max diameter of 6mm. Subsequent biopsies were obtained after improvement of luminal narrowing appreciated. Biopsies were positive for ER positive adenocarcinoma strongly indicating metastatic breast cancer with esophageal infiltration. Later, PET/CT obtained showing additional left lung and pleura of chest wall involvement, mediastinal lymph node involvement, and enhancement of pelvis. Laboratory data revealed elevated CEA and CA-125, normal CA-15-3. After diagnosis, patient treated with hormone therapy and chemotherapeutic agents. Discussion: Breast cancer metastases to the esophagus is often difficult to detect metastases as they are primarily located in the submucosa, thus diagnosis is often delayed until significant complications occur. Most patients present with some severity of dysphagia and has a high association with lower two-thirds esophageal strictures. There are two learning points regarding this case, one, it is important to consider malignancy and metastatic disease in the setting of abrupt onset food impaction in an otherwise healthy patient, two, special consideration should be given to patients with a history of breast cancer presenting with gastrointestinal distress despite long cancer free interval.
Disclosures: Rachael Weigle indicated no relevant financial relationships. Charles Carver indicated no relevant financial relationships. Suneel Mohammed indicated no relevant financial relationships. Gerald Mank indicated no relevant financial relationships.