S4299 Breast Carcinoma Causing Esophageal Stricture

Introduction: Breast cancer most commonly metastasizes to bone, liver, brain, and lung but rarely, can metastasize to the gastrointestinal tract. In this case report, we describe a patient presenting with severe, progressive dysphagia that was ultimately determined to be from a malignant esophageal stricture due to metastasized lobular breast carcinoma. Case Description/Methods: A 77-year-old woman with an ER/PR-positive, HER2-negative lobular breast carcinoma with known bone metastases presented with progressive dysphagia to solids and intermittently liquids. She had previously discontinued aromatase inhibitors due to poor tolerance and declined further treatment options out of concern for adverse effects. She underwent an endoscopy that demonstrated a 3 cm × 6 mm distal esophageal stricture (36-39 cm), traversable only with a super-slim XP160 scope. There was pale mucosa throughout the esophagus and markedly erythematous and nodular-appearing mucosa in the stomach. Dilation was not performed due to concern for malignancy and perforation. Biopsies of the fundus and more proximal esophagus were consistent with metastatic lobular carcinoma of the breast, but the stricture biopsy showed benign squamous epithelium, likely due to sampling error, as a computed tomography chest subsequently confirmed malignant infiltration from the fundus up through the distal esophagus. Discussion: Esophageal metastasis from breast cancer is rare, but this case illustrates a malignant stricture. Although the stricture biopsy was benign, other locations were positive for carcinoma with computed tomography chest confirming malignant infiltration. Prior reports show almost half of the cases with esophageal metastasis had benign biopsies on initial endoscopy likely due to the tumor progressing from the outer layers inward, making mucosal involvement and thus detection through sampling uncommon. This case highlights the need to consider metastasis in the appropriate patient, and obtain multiple biopsies to minimize sampling error and prevent the risks of dilation in setting of malignancy.