Solitary breast cancer metastasis to the esophagus – a multimodal diagnostic approach

Ziele: We present a case of late breast cancer metastasis over 15 years since the initial diagnosis which was unusual because of its solitary aspect and its uncommon localization in the esophagus. With a history of breast cancer several differential diagnoses for suspicious space occupying masses need to be considered. Methode: This is a 61-year-old female with a history of breast cancer and progressive dysphagia. Endoscopic ultrasound showed a mid-esophageal mass in the wall of the esophagus. CT demonstrated circumferential thickening of the esophageal wall with avid FDG uptake on a PET/CT. Biopsy showed poorly differentiated adenocarcinoma suggestive of gastrointestinal origin. However suspicion about a metastatic breast cancer metastasis was raised given the unusual location and her history of breast cancer. Additional immunhistochemical stains were positive for estrogen and progesteron receptors and confirmed the breast origin. Ergebnis: Gastrointestinal metastasis is rare but when it occurs it is mostly seen as a secondary involvement by direct spread. Distant metastases to the esophagus are exceptionally rare. Nevertheless for the esophagus breast cancer is one of the most frequent origins. We discussed a secondary radiation-induced cancer. In 16% of all cancers secondary primary malignancies occur whereas the overall incidence of multiple primary cancers is between 0,3 – 4,3%. Studies have shown the association of adenocarcinoma with carcinoma of the breast. Oddly we found adenocarcinoma in the middle third of the esophagus but adenocarcinoma usually appears in the distal third of the esophagus. The unusual localization and the history of breast cancer made us consider metastasis. Schlussfolgerung: In conclusion a solitary breast cancer metastasis to the esophagus is a rare finding. With a history of breast cancer several differential diagnoses like radiation-induced cancer or multiple neoplasm need to be considered. A multimodal diagnostic approach can lead to the correct diagnosis.

Korrespondierender Autor: Vieweg HC

Westkuestenklinikum Heide, Institut für Diagnostische und Interventionelle Radiologie, Esmarchstraße 50, 25746 Heide

E-Mail: [e-mail]

breast cancer - esophagus metastasis - PET CT