title: A rare recurrence of bilateral breast cancer in the esophagus coincidentally associated with primary gastric cancer: a case report.
abstract: BACKGROUND
  Cases of esophageal metastasis of breast cancer are extremely rare. We present the case of a patient who developed recurrence as esophageal metastasis following treatment of bilateral breast cancer. Early-stage gastric cancer was also found coincidentally.
  
  
  METHODS
  An 86-year-old Japanese female patient with a history of bilateral breast cancer was found to have a gastric mass on a medical examination. At 72 years of age, she had undergone a total mastectomy with level II axillary lymph node dissection (pT3N0M0 stage II). Left breast cancer was found at the age of 79. A total mastectomy was performed with level II axillary lymph node dissection (pT1N0M0 stage I). At the time of her current admission, our patient complained of dysphagia. A repeat gastrofiberscopy revealed a submucosal lesion in her middle esophagus, located 27cm distal to her incisors, as well as a known type I tumor of the gastric cardia. Computed tomography showed a mass lesion in her middle esophagus that had grown extraluminally and infiltrated the tracheal bifurcation and her left primary bronchus. A boring biopsy of the esophageal lesion was performed under ultrasonic monitoring, and a pathological diagnosis of poorly differentiated adenocarcinoma of the esophagus was obtained. The biopsy of the cardiac lesion revealed moderately differentiated adenocarcinoma of the stomach. The expression status of her hormone receptors indicated that the esophageal lesion reflected metastatic recurrence of her breast cancer with coincidental primary gastric cancer (cT1N0M0 stage IA).
  
  
  CONCLUSIONS
  Esophageal metastasis of breast cancer is extremely rare. An individualized treatment plan combining multimodal approaches should therefore be devised according to the patient's status.
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan. spqv9ke9@view.ocn.ne.jp.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Kashiwagi
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Onoda
authors.forename: Yuka
authors.initials: Y
authors.lastname: Asano
authors.forename: Satoru
authors.initials: S
authors.lastname: Noda
authors.forename: Hidemi
authors.initials: H
authors.lastname: Kawajiri
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takashima
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa