Minimally Invasive Esophagectomy for Metastatic Breast Cancer to Esophagus: A Rare Interesting Case Report

Nilay Shah, MD, MS, Suzanne Carpenter, MD, Kristi Harold, MD, Dawn Jaroszewski, MD

Mayo Clinic Arizona

Case Report: 62 year-old female presented with dysphagia secondary to 4-cm esophageal stricture. She had undergone lumpectomy and chemoradiation for breast cancer in 1994. Since 2007, she had undergone multiple esophagogastroduodenoscopy (EGD) for dilatation of the stricture. Multiple biopsies performed during EGD showed benign squamous cells and atypical glandular cells of uncertain significance. She also underwent esophageal stent placement 17 mm, 15-cm Polyflex stent with some improvement of symptom but never normal. She also had endoscopic ultrasonography (EUS) but neither the radial or linear endoscopes could be passed beyond 26 cm. Patient finally presented to gastroenterology department in Mayo Clinic in 2009 with dysphagia and around 60 pounds weight loss over a period of few months. At that time, she was only tolerating lilquid diet and was requiring monthly esophageal dilatations. Patient had another EGD and EUS which showed very tight fibrotic stricture from 26 to 31 cm in the midesophagus consistent with radiation-induced stricture on endoscopic ultrasound examination done by catheter probe endoscopic ultrasound. No evidence of residual or recurrent tumor or malignant periesophageal lymph nodes. Patient was finally referred to cardiothoracic surgery department and she was offered Minimally Invasive Esophagectomy. She underwent Minimally Invasive Transthoracic Esophagectomy as shown in figure. Surgical pathology showed invasive adenocarcinoma identified in the wall of the esophagus extending into the deeper muscularis propria. The tumor morphology was compatible with breast primary. Patient had postoperative anastomotic leak which was managed by esophageal stent placement. At 2 years follow-up, patient had EGD which showed no recurrence of cancer and widely patent anastomosis.

Conclusion: Isolated metastasis to esophagus in Stage IV breast cancer can be managed by Minimally Invasive Esophagectomy with decreased morbidity and less risk of recurrence. . Even though esophageal metastasis of breast cancer is rare, high index of suspicion should be maintained in patients who presents with dysphagia with history of breast cancer.