Endosonographic Features of Metastatic Breast Cancer in the Esophagus: Report of a Case

食道的轉移性癌症不多，而乳癌造成的食道轉移更加少見。由於食道轉移通常侵犯到黏膜下層、臨床表現不明顯、而且有長的無疾病期(Disease-free interval)，因此造成診斷上的困難。我們報告一位10年前接受過乳癌切除手術的58歲女性，他的主訴是間歇性的吞嚥困難。食道攝影及胸部電腦斷層顯示中段食道狹窄，但是並沒有發現縱膈腔腫瘤或林巴節的壓迫。胃鏡及內視鏡超音波檢查發現一個內視鏡無法通過的狹窄，表面黏膜完整但是有整圈的食道壁增厚，包含黏膜下層及黏膜肌肉層的浸潤。由於症狀沒有緩解而且黏膜切片不能提供明確的診斷，因此他接受了局部的食道切除併淋巴節摘除。病理報告顯示分化不良的腺癌從黏膜下層侵犯到外膜邊緣，而淋巴結轉移也呈現陽性反應。腫瘤的螢光免疫染色顯示動情激素接受器及黃體酮接受器都呈陽性，更確定乳癌轉移到食道的診斷。儘管內視鏡超音波被認爲是食道癌及食道狹窄最好的局部診斷工具，關於內視鏡超音波在轉移性食道癌造成狹窄的表現及診斷角色的報告仍然很少。就我們所知，自1995年開始，在英語文獻上只找到9例有手術前的內視鏡超音波檢查。我們提出這一例病例報告並整理前人的經驗，希望有助於早期的診斷及治療。總而言之，對有乳癌病史的停經婦女，假如其表現吞嚥困難而且內視鏡超音波顯示黏膜下食道壁增厚，要高度懷疑有食道的轉移。

關鍵字

內視鏡超音波；食道狹窄；轉移性乳癌

並列摘要

Metastatic esophageal cancer is uncommon, and metastatic breast cancer in the esophagus is even rarer. Diagnosis is difficult because of the submucosal infiltration pattern, long disease-free interval and unusual clinical course. This report describes a 58-year-old female presenting with intermittent dysphagia and a 10-year history of breast cancer and mastectomy. Esophagography and chest CT scan showed esophageal stricture at middle third portion without mediastinal tumor or lymph node compression. Subsequent endoscopy and EUS revealed impassible esophageal stenosis with intact mucosal surface but circumferential wall thickening and infiltration on submucosal and muscularis proprial layers. Due to inconclusive mucosal biopsy and persistent symptoms, she underwent segmental esophagectomy and lymph node dissection. Pathology demonstrated poorly differentiated adenocarcinoma, infiltration from submucosa to advential margin with positive lymph node metastasis. Additionally, immunohistochemical staining disclosed positive findings of esotrogen and progesterone receptors on malignant cells, indicating metastatic breast cancer in the esophagus. Although EUS is considered the best imaging modality in locoregional staging of esophageal malignancy and differentiation of esophageal stenosis, few reports have described the features of EUS on metastatic breast cancer in the esophagus. In conclusion, a high index of suspicion for esophageal metastasis is warranted in postmenopausal females with history of breast carcinoma presenting with dysphagia and esophageal wall thickening beneath mucosa on EUS.

並列關鍵字

endoscopic ultrasound ； esophageal stricture ； metastatic breast cancer

國際替代計量

Endosonographic Features of Metastatic Breast Cancer in the Esophagus: Report of a Case

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