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

Abstract

Esophageal cancer (EC) is a highly lethal disease. Approximately 50% of patients present with metastatic EC and most patients with localized EC will have local recurrence or develop metastases, despite potentially curative local therapy. The most common sites of distant recurrence are represented by lung, liver and bone while brain and breast metastases are rare. Usually patients with advanced disease are not treated aggressively and their median survival is six months. We report a woman patient who developed breast and brain metastases after curative surgery. We treated her with a highly aggressive chemotherapeutic and surgical combination resulting in a complete remission of the disease even after 11-year follow-up. We think that in super selected patients with more than one metastasis, when functional status is good and metastases are technically resectable, a surgical excision may be considered as a salvage option and chemotherapy should be delivered to allow a systemic control.

Figure 1

Barium swallow shows the presence of a stenotic trait in the middle thoracic esophagus.

Figure 2

Esophageal histological sample (haematoxylin-eosin stain 20 x) shows the presence of squamous cell carcinoma with involvement of muscular tunic.

Figure 3

A squamous pearl at a higher magnification (haematoxylin-eosin stain 200 x).

Figure 4

Mammography shows a well-defined nodule without calcification.

Figure 5

The right side of breast histological sample shows an infiltranting squamous carcinoma’s focus with peritumoral inflammation while the left side shows a normal mammary duct section (haematoxylin-eosin stain 40 x).

Figure 6

Squamous carcinoma infiltrating the cerebral parenchyma (haematoxylin-eosin stain 100 x).