Successful outcome after combined chemotherapeutic and surgical management in a case of esophageal cancer with breast and brain relapse

Brain metastases from esophageal cancer: A case report

INTRODUCTION

At present, there is no uniform consensus on the treatment of brain metastases from esophageal cancer. The studies on the treatment of brain metastases from esophageal cancer by radiotherapy combined with temozolomide (TMZ) are even rarer.

PATIENT CONCERNS

A 69-year-old woman was admitted to our hospital for brain metastases from esophageal cancer after thoracic irradiation.

DIAGNOSES

Magnetic resonance imaging of the head showed a round, heterogeneous metastatic tumor in the left parietal lobe. Brain magnetic resonance imaging showed edema around brain metastasesInterventions: After radiotherapy plus TMZ in this patient's head, the brain metastatic tumor was significantly decreased.

OUTCOMES

At the end of radiotherapy, and 1 and 2 months after the end of radiotherapy, the metastatic tumor continued to shrink, and no obvious side effects were observed.

LESSONS

This study suggests that radiotherapy plus TMZ might be a feasible option for brain metastases from esophageal cancer.

Esophageal Cancer Metastases to Unexpected Sites: A Systematic Review

The most common pattern of esophageal cancer metastases (ECM) is to the lymph nodes, lung, liver, bones, adrenal glands, and brain. On the other hand, unexpected metastasis (UM) spread to uncommon sites has increasingly reported and consequently affected the pathway of diagnosis, staging, and management. Using the PubMed database, a systematic search of the following headings “Esophageal” and “Metastasis” or “Metastases” was performed, 10049 articles were identified, and the articles were included if they demonstrated unexpected ECM. 84% of cases were men with an average age of 60.7 years. EC was located in the lower third in 65%. Two-thirds of the UM originated from the lower esophagus, and the two major histological types were adenocarcinoma 40% and squamous cell carcinoma 60%. Metastases were disseminated toward five main anatomical sites: the head and neck (42%), thoracic (17%), abdomen and pelvis (25%), extremities (9%), and multiple skin and muscle metastases (7%). The EC metastases were found to be synchronous 42% and metachronous 58%, isolated in 53.5% and multiple in 46.5%. The overall survival rate was 10.2 months. Since distant metastases are responsible for most EC-related deaths, understanding of ECM dissemination patterns needs more extensive studies. These critical data are the cornerstone of optimal cancer approach and treatment.

The "reverse breast-oesophagus syndrome": metastatic carcinosis of breast in oesophageal cancer

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.

Breast Metastasis in Esophagus Cancer: Literature Review and Report on a Case

Esophagus cancer metastases often involve locoregional lymph nodes, lung, bone, liver, and brain. Metastatic involvement of the breast from esophagus cancer is uncommon, but if it happened, it usually presents as a part of multiple organ distal metastases. Here we report a case of the largest metastatic esophagus cancer of the breast and the chest wall, and we review the similar reported cases.

Breast metastasis from esophagogastric junction cancer: a case report

Metastasis to breast from nonmammary malignancy is only about 1.3–2.7%. A few cases of squamous cell carcinoma of esophagus and adenocarcinoma of stomach metastasizing to breast have been reported, but this is probably the first report of breast metastasis from esophagogastric junction (EGJ) cancer in the English literature. Herein we report a case of a 32-year-old patient diagnosed as adenocarcinoma of gastroesophageal junction, presenting with left breast metastasis two years after treatment. Given unusual site of metastasis in a follow-up case of EGJ cancer, not only it is challenging to differentiate it from primary carcinoma of breast but also it is important from treatment point of view. In our case, clinical data, radiology, histopathology, and immunohistochemistry (IHC) led us to reach the diagnosis.

Chemo/Tomotherapy Stereotactic Body Radiation Therapy (chemo/SBRT) for the Salvage Treatment of Esophageal Carcinoma following Trimodality Therapy: A Case Report

Background

Esophageal cancer (EC) patients presenting a local recurrence following trimodality therapy (chemoradiaton and surgery) have limited palliative treatment options when the three major modalities of therapy have been exhausted. In addition, some patients experience a local recurrence or develop a metachronous cancer in a previously irradiated site, without evidence of systemic disease. For these patients there is a potential for cure, although the risk of further distant recurrences remains high.

Case report

We report of a successful concomitant chemo/SBRT treatment in a case of locally advanced metachronous squamous cervical EC, which was diagnosed in a patient previously treated with trimodality therapy for a squamous tonsillar carcinoma.

Result

Chemo/SBRT seems to be a reasonable salvage option for patients without distant metastases who have exhausted standard therapies.

Conclusions

Our experience also suggests that a concomitant chemo/SBRT treatment appears to be either feasible or effective and chemo/SBRT can be considered also in selected patients affected by EC with squamous histology and with neoplastic infiltration of the trachea.

Occurrence and clinical features of brain metastasis after chemoradiotherapy for esophageal carcinoma

Brain metastasis from esophageal carcinoma has been considered rare and survival following esophageal carcinoma with distant metastasis is poor. The purpose of this report was to clarify cumulative incidence and risk factors for brain metastasis after chemoradiotherapy for esophageal carcinoma, and to consider recommended treatments for brain metastasis from esophageal carcinoma. We reviewed 391 patients treated with chemoradiotherapy. Median age was 65 years. Clinical stages were I, II, III, and IV in 32, 47, 150, and 162 patients, respectively. Brain imaging was performed usually when patients revealed neurological symptoms. The 3-year cumulative incidence of brain metastasis after chemoradiotherapy was 6.6%. There were 4 patients with single metastasis and 8 with multiple metastases. Initial clinical stages were II, III, and IV in 1, 2, and 9 patients, respectively. Histology included squamous cell carcinoma in 10 patients and others in 2 patients. Univariate analysis demonstrated M factor, distant lymph node relapse, and recurrent lung and liver metastasis as significant risk factors of brain metastasis (P < 0.05). Median survival time after diagnosis of brain metastasis was 2.1 months. Brain metastasis was not directly related to cause of mortality. The causes were extracranial tumor deterioration in 8 patients and infection in 4 patients. Brain metastasis may increase in the future with improving survival from esophageal carcinoma. However, considering the poor survival after diagnosis of brain metastasis, short-term palliative therapy for brain metastasis appears preferable to vigorous long-term therapy.

Breast mass as the initial presentation of esophageal carcinoma: a case report

Introduction

Esophageal cancer is considered as a fatal malignancy. It mostly metastasizes to lung, liver, and bone while breast metastasis has been rarely reported. This is the fifth report of metastatic breast cancer from esophageal cancer, which differs from previous reported cases in terms of initial presentation with metastatic breast mass and no metastatic involvement of other organs.

Case presentation

We present a 35-year-old Caucasian woman who initially complained of a painful breast mass. Squamous pearls on cytologic evaluation suggested a metastatic lesion. Two months history of dysphagia was extracted through detailed interview with patient and further investigation revealed a stage IV esophageal squamous cell carcinoma.

Conclusion

In this case, breast lesion as an unusual presentation of esophageal carcinoma emphasizes the great role of thorough medical history taking and cytologic study in evaluating an accidentally detected breast mass. The increasing reports of breast metastasis in patients with esophageal carcinoma necessitate the careful breast examination in visits after treatment of the primary tumor.

Breast metastasis from small cell lung carcinoma

Breast metastases from extramammary neoplasms are very rare. We presented a 66 year-old female with metastasis of small cell lung carcinoma to the breast. She presented with consolidation over the left upper lobe of her lung undetermined after endobronchial or video-assisted thoracoscopic surgery (VATS) biopsy, and this was treated effectively after antibiotic therapy at initial stage. The left breast lumps were noted 4 months later, and she underwent a modified radical mastectomy under the impression of primary breast carcinoma. However, the subsequent chest imaging revealed re-growing mass over the left mediastinum and hilum, and cells with the same morphological and staining features were found from specimens of transbronchial brushing and biopsy. An accurate diagnosis to distinguish a primary breast carcinoma from metastatic one is very important because the therapeutic planning and the outcome between them are different.