Esophageal Strictures due to Mediastinal Metastases from Breast Cancer

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.