Esophageal perforation due to breast cancer metastasis: Case report

Abstract

Introduction: Breast cancer metastasis to the esophagus is rare and can appear after a long period after remission. The lesions are frequently found on lung, liver, bone, soft tissue, brain and adrenal glands. Although the esophagus is a rare location, the distal part is the most common site of lesions and they can appear with clinical signs of stricture, with an incidence of 4% to 5% in some series reported in the literature.
Case presentation: A 64-year-old woman with history of breast cancer treated with mastectomy, chemotherapy and radiotherapy currently in remission was referred to our center presenting stenosis of the esophagus and perforation that was treated with previously with a pleural patch that presented leakage requiring laparoscopic esophagectomy with gastric ascent. The patient had a good postoperative recovery, and was discharged to continue follow up as an outpatient. The surgical piece was examined with a final pathology report of breast cancer metastasis on the esophagus (ductal carcinoma) at the site of the stenosis and was referred to an Oncology service.
Discussion: Although breast carcinoma represents a frequent source of metastases to the gastrointestinal tract, esophageal lesions are a rare entity. There is a low percentage of patients diagnosed endoscopically in the preoperative period due to the low incidence and the involvement of submucosa which makes obtaining a good sample difficult. These lesions can occur without symptomatology in a large number of patients, dysphagia is the most common symptom. Endoscopic resection is a suitable option with adequate results and is considered a safe method, however, is difficult to identify this pathology before it manifests clinically. In the scenario of complication, the minimally invasive approach provides a good option for a better postoperative recovery.