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1
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Medas R, Mussagi G, Moutinho-Ribeiro P, Lopes J, Macedo G. Middle-Age New-Onset Dysphagia. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:221-223. [PMID: 38836122 PMCID: PMC11149985 DOI: 10.1159/000534263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/11/2023] [Indexed: 06/06/2024]
Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Gany Mussagi
- Gastroenterology Department, Maputo Central Hospital, Maputo, Mozambique
| | - Pedro Moutinho-Ribeiro
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Joanne Lopes
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
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2
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Da Cunha T, Restrepo D, Abi-Saleh S, Dharan M. Breast cancer metastasizing to the upper gastrointestinal tract (the esophagus and the stomach): A comprehensive review of the literature. World J Gastrointest Oncol 2023; 15:1332-1341. [PMID: 37663940 PMCID: PMC10473935 DOI: 10.4251/wjgo.v15.i8.1332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/01/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023] Open
Abstract
Breast cancer can infrequently metastasize to the upper gastrointestinal (GI) tract but the exact incidence is not well established-there is considerable variation between incidence reported from clinical studies and incidence noted in autopsy series. Clinical presentation can be very non-specific and often mimics primary gastrointestinal conditions. Endoscopy alone may not be sufficient to make a diagnosis and misdiagnosis is also common. A high degree of awareness and clinical suspicion is required to establish metastases to the upper GI tract. We undertook a comprehensive review of the available literature on breast cancer metastases to the esophagus and stomach including the clinical symptoms and presentation, endoscopic features, additional diagnostic imaging modalities, treatment and outcomes.
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Affiliation(s)
- Teresa Da Cunha
- Department of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - David Restrepo
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - Simon Abi-Saleh
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - Murali Dharan
- Department of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT 06030, United States
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3
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Balázs Á, Vass T, Baranyai Z. Esophageal Strictures due to Mediastinal Metastases from Breast Cancer. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03369-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AbstractMediastinal metastases represent an infrequent recurrence of breast carcinoma. Esophageal involvement by metastatic tissue is extremely rare. The situation means an unusual diagnostic and therapeutic challenge. Dignity of esophageal stricture is difficult to ascertain; endoscopy and picture giving methods might be conflicting. This study aimed to analyze the clinical characteristics and the therapeutic possibilities of the condition. A retrospective analysis of malignant esophageal stricture cases was performed from a prospectively collected database between 1984 and 2020. Out of 3996 cases with esophageal malignancy, 17 esophageal strictures were confirmed to be related to breast cancer metastasis. Surgical resection was feasible in 3 cases; endoprosthesis insertion was performed for palliation in 7 cases, and in 7 cases, only supportive care was available. Our incidence rate was 0.43%. Dysphagia indicating an affected esophagus presented on average 10.5 years after the primary tumor surgery. Mean duration between onset of symptoms achieving appropriate diagnosis was 6.4 months. Dignity of the malignancy was confirmed only retrospectively in one case. Morphologic findings showed an external esophageal compression in 52.9%, while in 35.3%, a destructive tumor growth affecting the mucosal layer could be found. Overall, survival was 7.6 months referring to 15 cases. The possible occurrence of mediastinal metastases involving the esophagus should be seriously considered in patients with previous breast cancer history. Biopsies obtained from the intact mucosal surface of the stenotic esophagus are often inefficient and misleading; therefore, repeated biopsies are necessary. Options for radical surgery are highly limited.
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4
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Alfian Sulai DD, Krishnasamy T, Nik Mahmood NRK. Diagnostic challenge in silent metastatic invasive breast carcinoma: dysphagia as the only symptom. BMJ Case Rep 2021; 14:14/7/e239997. [PMID: 34290001 DOI: 10.1136/bcr-2020-239997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Metastatic cancer to the oesophagus is rare. Most cases are diagnosed at autopsy or surgery. The breast is the most common organ bearing a primary tumour. Metastatic oesophageal tumours are nearly always located in the submucosal layer with normal benign-looking mucosa, rendering tissue diagnosis difficult. In the absence of breast-related symptoms, the diagnosis of oesophageal metastasis from breast primary would be very challenging. We report a case of a 50 year-old woman, who was referred to our centre for a second opinion after she was offered an esophagectomy for a suspected oesophageal carcinoma. She presented solely with dysphagia and weight loss. Multiple investigations were performed to investigate her dysphagia which eventually led to the diagnosis of metastatic breast cancer with oesophageal involvement. She underwent excision of right breast invasive lobular carcinoma with axillary dissection. She completed her adjuvant chemoradiotherapy and currently on daily dose of tamoxifen, whereby her dysphagia has dramatically improved.
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Affiliation(s)
| | - Theevashini Krishnasamy
- Department of Surgery, Universiti Teknologi MARA Fakulti Perubatan Kampus Sungai Buloh, Sungai Buloh, Malaysia
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5
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Anwar SL, Avanti WS, Choridah L, Dwianingsih EK, Hardiyanto H, Aryandono T. Concurrent manifestations of Horner's syndrome and esophageal metastasis of breast cancer: case report of a young woman after a period of non-adherence to treatment: a case report. J Med Case Rep 2021; 15:194. [PMID: 33836802 PMCID: PMC8035740 DOI: 10.1186/s13256-021-02688-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Esophageal involvement and Horner's syndrome are rare manifestations of breast cancer distant metastases that can pose a significant challenge in diagnosis and treatment. In addition to the more aggressive behavior of breast cancer diagnosed in young women, non-adherence to treatment is associated with increased risk of distant metastasis. CASE PRESENTATION A 36-year-old Javanese woman presented to our institution with dysphagia, hoarseness, and frequent hiccups. In the 6 weeks prior to the current admission, the patient also reported tingling in the neck and shoulder, anhidrosis in the left hemifacial region, and drooping of the upper left eyelid. She was previously managed as tuberculoid laryngitis. Plain X-rays showed burst fractures of the cervical vertebrae and slight pleural effusion. Laryngoscopy revealed bowing of the vocal cords and liquid residue in the vallecula that was reduced upon chin tuck. Esophageal metastasis was confirmed with endoscopy showing thickening of the wall and positive cytology swab with ductal malignant cells. The patient had a history of breast cancer with a period of loss to follow-up of 4 years. CONCLUSIONS Physicians should consider potential distant metastasis of breast cancer to the esophagus and sympathetic nervous system of the neck particularly in a high-risk woman with presentation of dysphagia and manifestations of Horner's syndrome.
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Affiliation(s)
- Sumadi Lukman Anwar
- Division of Surgical Oncology-Department of Surgery, Dr. Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan No. 1, Yogyakarta, 55281, Indonesia.
| | - Widya Surya Avanti
- Department of Radiology, Dr. Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Lina Choridah
- Department of Radiology, Dr. Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Ery Kus Dwianingsih
- Department of Anatomical Pathology, Dr. Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Herjuna Hardiyanto
- Division of Surgical Oncology-Department of Surgery, Dr. Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan No. 1, Yogyakarta, 55281, Indonesia
| | - Teguh Aryandono
- Division of Surgical Oncology-Department of Surgery, Dr. Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan No. 1, Yogyakarta, 55281, Indonesia
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6
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Asai S, Fukaya M, Fujieda H, Igami T, Tsunoda N, Sakatoku Y, Kamei Y, Miyata K, Nagino M. Esophageal reconstruction using a pedicled jejunum following esophagectomy for metastatic esophageal stricture from breast cancer in a patient with previous pancreatoduodenectomy. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 81:679-685. [PMID: 31849385 PMCID: PMC6892670 DOI: 10.18999/nagjms.81.4.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 71-year-old woman with dysphagia was diagnosed with thoracic esophageal squamous cell carcinoma by endoscopic biopsy at another hospital. She had previously undergone partial breast excision with axillary lymph node dissection for right breast cancer eleven years earlier and subtotal stomach-preserving pancreatoduodenectomy with Child’s reconstruction for ampullary cancer ten years earlier. Gastrointestinal endoscopy showed a stricture due to a bulging submucosal tumor in the mid-thoracic esophagus. The tumor was diagnosed as an esophageal metastasis from breast cancer by endoscopic ultrasound-guided fine-needle aspiration biopsy. After six courses of fulvestrant, the tumor progressed, completely impeding her ability to swallow. An esophagectomy was planned in a one-stage operation because of the expectation of a prolonged survival and her strong hope of regaining oral intake. Unfortunately, she underwent emergent omental patch repair for perforation of the gastrojejunostomy site due to an anastomotic ulcer one day before the scheduled operation. Due to postoperative impairment of her performance status, she subsequently underwent a two-stage esophageal operation. In the first surgical stage, prone position thoracoscopic esophagectomy and cervical esophagostomy were performed and she was discharged with enteral nutrition on postoperative day 15. Sixty-one days after the first surgical stage, esophageal reconstruction was performed using a pedicled jejunum with microvascular anastomosis via the subcutaneous route. She was discharged without any complications 20 days after the second operation.
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Affiliation(s)
- Soichiro Asai
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahide Fukaya
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hironori Fujieda
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Tsunoda
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yayoi Sakatoku
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazushi Miyata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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7
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Su H, Wu J, Liu H, Wei N, Lin W, Zhou Q, Wang M, Lv S, Yang Y. Review of esophageal metastasis from breast cancer. Gland Surg 2020; 9:417-422. [PMID: 32420267 DOI: 10.21037/gs.2020.04.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Esophageal metastasis of primary breast cancer is rare, with nearly all the literature on this topic consisting of case report studies. When breast cancer patients complain of progressive dysphagia after a long disease-free interval after breast surgery, they may be treated and misdiagnosed with a second primary. Our aim was to review all the literature concerning esophageal metastasis of breast cancer, for the purpose of improving the awareness in identifying these patients and providing them proper treatment.
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Affiliation(s)
- Hui Su
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China.,Department of Gastroenterology, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, China
| | - Jing Wu
- Department of Gastroenterology, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, China
| | - Hong Liu
- Department of Gastroenterology, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, China
| | - Nan Wei
- Department of Gastroenterology, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, China
| | - Wu Lin
- Department of Gastroenterology, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, China
| | - Quan Zhou
- Department of Pathology, Capital Medical University Affiliated Beijing Shijitan Hospital, Haidian District, Beijing 100038, China
| | - Miaomiao Wang
- Department of Gastroenterology, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, China
| | - Shuzhen Lv
- Department of Breast surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing 100038, China
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China
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8
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Esophageal Metastases from Breast Carcinoma: a Rare Delayed Metastases After 15 Years. J Gastrointest Cancer 2020; 50:674-677. [PMID: 29717415 DOI: 10.1007/s12029-018-0109-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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9
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Dhanushkodi M, Sundersingh S, Krishnamurthy A. Oesophageal Metastasis from Breast Cancer: Mimicker of Primary Oesophageal Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Liu A, Feng Y, Chen B, Li L, Wu D, Qian J, Yang A. A case report of metastatic breast cancer initially presenting with esophageal dysphagia. Medicine (Baltimore) 2018; 97:e13184. [PMID: 30407355 PMCID: PMC6250498 DOI: 10.1097/md.0000000000013184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Breast cancer metastasis to the esophagus is uncommon. To our knowledge, the present case is the first report of breast cancer with dysphagia as the initial symptom. PATIENT CONCERNS A 62-year-old woman was admitted to our hospital for progressive dysphagia. DIAGNOSES Endoscopic ultrasound-guided fine needle biopsy of the esophageal lesion found poorly differentiated carcinoma, and surgical resection of the breast nodule revealed invasive ductal carcinoma. INTERVENTIONS The patient underwent an esophagectomy, and the immunohistochemistry of surgical specimen was identified as metastatic breast cancer. Then patient was treated with chemotherapy and hormone therapy. OUTCOMES The patient remained symptom-free during 5 months of follow-up examinations. LESSONS This case indicates that metastatic breast cancer to the esophagus should be considered as a cause of esophageal stricture in older women.
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Affiliation(s)
| | | | | | - Li Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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11
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Teh GXJ, Tan D, Khor JL, Wan WK, Wang YT. Esophageal Metastatic Adenocarcinoma Diagnosed with Endoscopic Ultrasound. Case Rep Gastroenterol 2017; 11:694-700. [PMID: 29430220 PMCID: PMC5803709 DOI: 10.1159/000484133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/10/2017] [Indexed: 12/27/2022] Open
Abstract
Metastasis to the esophagus from a distant primary cancer is a rare manifestation in a patient with a history of oncological disease presenting with obstructive upper gastrointestinal symptoms. Computed tomography of the thorax or esophagogastroduodenoscopy can be non-diagnostic as the disease tends to be submucosal. In such a situation, endoscopic ultrasound (EUS) with fine needle aspiration (FNA) can be directed to characterize and sample the submucosal esophageal lesion. We present a case series of metastatic esophageal strictures diagnosed with EUS and FNA.
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Affiliation(s)
| | - Damien Tan
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Jen Lock Khor
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Wei Keat Wan
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Yu Tien Wang
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
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12
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Metastatic Breast Cancer Presenting as Esophageal Stricture. Clin Gastroenterol Hepatol 2017; 15:A33-A34. [PMID: 28428102 DOI: 10.1016/j.cgh.2017.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/08/2017] [Accepted: 04/10/2017] [Indexed: 02/07/2023]
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13
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Reghunath A, Agarwal Y, Chawla AS, Mittal MK, Gupta S. The "reverse breast-oesophagus syndrome": metastatic carcinosis of breast in oesophageal cancer. BJR Case Rep 2016; 2:20150510. [PMID: 30460032 PMCID: PMC6243322 DOI: 10.1259/bjrcr.20150510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/26/2016] [Indexed: 11/05/2022] Open
Abstract
A "breast-oesophagus syndrome" has been described previously, wherein breast carcinoma metastasizes to the inner layers of the oesophagus. The entity is extremely rare, but rarer still is metastatic breast carcinosis from oesophageal cancer (EC), a clinical event that might be termed as "reverse breast-oesophagus syndrome". Considered as the sixth most lethal malignancy, 50% EC patients present with metastatic disease. However, they rarely ever metastasize to the breast. For that reason, a malignant breast mass, which develops following EC, is often thought of as a second malignancy. We report a 62-year-old female who had EC, who was treated with oesophagectomy 2 years ago, and represented with a painful left breast mass. Radiological evaluation revealed suspicious findings (breast imaging-reporting and data system score of 4C), while cytology demonstrated squamous pearls, consistent with metastatic squamous cell EC, which probably disseminated to the breast at the time of surgery. She was treated with local excision of the breast mass, which is the treatment of choice in isolated metastasis to the breast. Such an unusual presentation reminds us that, in any "radiologically suspicious" breast lesion in patients with a history of carcinoma of the oesophagus, the possibility of breast metastasis must not be negated.
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Affiliation(s)
- Anjuna Reghunath
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Yatish Agarwal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Avneet Singh Chawla
- Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mahesh Kumar Mittal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Swarna Gupta
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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14
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Wilson MA, Shah N, O'Donnell ME, Jaroszewski DE. An unusual presentation of esophageal metastasis from breast cancer. J Thorac Cardiovasc Surg 2015; 149:e110-2. [PMID: 25816959 DOI: 10.1016/j.jtcvs.2015.02.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 02/05/2015] [Accepted: 02/19/2015] [Indexed: 12/28/2022]
Affiliation(s)
- Megan A Wilson
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Ariz
| | - Nilay Shah
- Department of Surgery, Mayo Clinic Hospital, Phoenix, Ariz
| | | | - Dawn E Jaroszewski
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Ariz.
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15
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Abdel Aal M, Scheer F, Andresen R. Ectopic mediastinal thyroid tissue with a normally located thyroid gland. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e7054. [PMID: 25785182 PMCID: PMC4347798 DOI: 10.5812/iranjradiol.7054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/11/2012] [Accepted: 12/16/2012] [Indexed: 11/16/2022]
Abstract
Ectopic thyroid tissue (ETT) is a rare entity and a challenging differential diagnosis. This is a report of a case of a mediastinal mass that was found to be an ectopic mediastinal thyroid tissue, in a 77-year-old woman who was admitted to our hospital for breast cancer management. The mediastinal mass was identified in the postsurgical computed tomography (CT) scan of the chest and was suspected as mediastinal lymph node metastasis. A CT-guided percutaneous transthoracic punch biopsy (CT-TPB) proved to be an adequate diagnostic tool to exclude malignancy and provide a definite diagnosis of the mediastinal mass. We find that CT-guided punch biopsy as a useful diagnostic alternative enabling histopathological specimens to be obtained from mediastinal masses and lymph nodes suspected of malignancy.
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Affiliation(s)
- Mohamed Abdel Aal
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, West Kusten Klinikum Heide Academic Teaching Hospital, Universities of Kiel, Lubeck, Germany
| | - Fabian Scheer
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, West Kusten Klinikum Heide Academic Teaching Hospital, Universities of Kiel, Lubeck, Germany
| | - Reimer Andresen
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, West Kusten Klinikum Heide Academic Teaching Hospital, Universities of Kiel, Lubeck, Germany
- Corresponding author: Reimer Andresen, Institute of Diagnostic and Interventional Radiology/Neuroradiology, West Kusten Klinikum Heide Academic Teaching Hospital, Universities of Kiel, Lubeck, Germany. Tel: +49-4817852401, Fax: +49-4817852409, E-mail:
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16
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Morton LM, Gilbert ES, Hall P, Andersson M, Joensuu H, Vaalavirta L, Dores GM, Stovall M, Holowaty EJ, Lynch CF, Curtis RE, Smith SA, Kleinerman RA, Kaijser M, Storm HH, Pukkala E, Weathers RE, Linet MS, Rajaraman P, Fraumeni JF, Brown LM, van Leeuwen FE, Fossa SD, Johannesen TB, Langmark F, Lamart S, Travis LB, Aleman BMP. Risk of treatment-related esophageal cancer among breast cancer survivors. Ann Oncol 2012; 23:3081-3091. [PMID: 22745217 PMCID: PMC3501231 DOI: 10.1093/annonc/mds144] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 04/10/2012] [Accepted: 04/16/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Radiotherapy for breast cancer may expose the esophagus to ionizing radiation, but no study has evaluated esophageal cancer risk after breast cancer associated with radiation dose or systemic therapy use. DESIGN Nested case-control study of esophageal cancer among 289 748 ≥5-year survivors of female breast cancer from five population-based cancer registries (252 cases, 488 individually matched controls), with individualized radiation dosimetry and information abstracted from medical records. RESULTS The largest contributors to esophageal radiation exposure were supraclavicular and internal mammary chain treatments. Esophageal cancer risk increased with increasing radiation dose to the esophageal tumor location (P(trend )< 0.001), with doses of ≥35 Gy associated with an odds ratio (OR) of 8.3 [95% confidence interval (CI) 2.7-28]. Patients with hormonal therapy ≤5 years preceding esophageal cancer diagnosis had lower risk (OR = 0.4, 95% CI 0.2-0.8). Based on few cases, alkylating agent chemotherapy did not appear to affect risk. Our data were consistent with a multiplicative effect of radiation and other esophageal cancer risk factors (e.g. smoking). CONCLUSIONS Esophageal cancer is a radiation dose-related complication of radiotherapy for breast cancer, but absolute risk is low. At higher esophageal doses, the risk warrants consideration in radiotherapy risk assessment and long-term follow-up.
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Affiliation(s)
- L M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA.
| | - E S Gilbert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - P Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - M Andersson
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Joensuu
- Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - L Vaalavirta
- Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - G M Dores
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA; US Department of Veterans Affairs Medical Center, Oklahoma City
| | - M Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, USA
| | - R E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - S A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R A Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - M Kaijser
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - H H Storm
- Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - E Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - R E Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - P Rajaraman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - J F Fraumeni
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - L M Brown
- Statistics & Epidemiology, RTI International, Rockville, USA
| | - F E van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S D Fossa
- Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | | | - S Lamart
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - L B Travis
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, USA
| | - B M P Aleman
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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