Concurrent manifestations of Horner’s syndrome and esophageal metastasis of breast cancer: case report of a young woman after a period of non-adherence to treatment: a case report

Anwar S.L., Avanti W.S., Choridah L., Dwianingsih E.K., Hardiyanto H., Aryandono T.

Division of Surgical Oncology-Department of Surgery, Dr. Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan No. 1, Yogyakarta, 55281, Indonesia; Department of Radiology, Dr. Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia; Department of Anatomical Pathology, Dr. Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia


Abstract

Background: Esophageal involvement and Horner’s syndrome are rare manifestations of breast cancer distant metastases that can pose a significant challenge in diagnosis and treatment. In addition to the more aggressive behavior of breast cancer diagnosed in young women, non-adherence to treatment is associated with increased risk of distant metastasis. Case presentation: A 36-year-old Javanese woman presented to our institution with dysphagia, hoarseness, and frequent hiccups. In the 6 weeks prior to the current admission, the patient also reported tingling in the neck and shoulder, anhidrosis in the left hemifacial region, and drooping of the upper left eyelid. She was previously managed as tuberculoid laryngitis. Plain X-rays showed burst fractures of the cervical vertebrae and slight pleural effusion. Laryngoscopy revealed bowing of the vocal cords and liquid residue in the vallecula that was reduced upon chin tuck. Esophageal metastasis was confirmed with endoscopy showing thickening of the wall and positive cytology swab with ductal malignant cells. The patient had a history of breast cancer with a period of loss to follow-up of 4 years. Conclusions: Physicians should consider potential distant metastasis of breast cancer to the esophagus and sympathetic nervous system of the neck particularly in a high-risk woman with presentation of dysphagia and manifestations of Horner’s syndrome. © 2021, The Author(s).

Breast cancer; Diagnosis; Esophageal metastasis; Horner’s syndrome; Low adherence


Journal

Journal of Medical Case Reports

Publisher: BioMed Central Ltd

Volume 15, Issue 1, Art No 194, Page – , Page Count


Journal Link: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85104147337&doi=10.1186%2fs13256-021-02688-7&partnerID=40&md5=2e3eedc23fd47b0236dd2853a51b8c55

doi: 10.1186/s13256-021-02688-7

Issn: 17521947

Type: All Open Access, Gold, Green


References

Kennecke, H., Yerushalmi, R., Woods, R., Cheang, M.C.U., Voduc, D., Speers, C.H., Metastatic behavior of breast cancer subtypes (2010) J Clin Oncol., 28 (20), pp. 3271-3277; Anwar, S.L., Avanti, W.S., Nugroho, A.C., Choridah, L., Dwianingsih, E.K., Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia (2020) World J Surg Oncol., 18 (1), pp. 117-133; Gallups, S.F., Connolly, M.C., Bender, C.M., Rosenzweig, M.Q., Predictors of adherence and treatment delays among African American women recommended to receive breast cancer chemotherapy (2018) Women’s Heal Issues., 28 (6), pp. 553-558; Miyake, M., Yamada, A., Miyake, K., Endo, I., Esophageal metastasis of breast cancer during endocrine therapy for pleural dissemination 21 years after breast surgery: a case report (2019) Surg Case Reports., 5 (1), p. 22; Kovacic, S., Lovrencic-Huzjan, A., Drpa, G., Hat, J., Belina, S., Horner’s syndrome as an initial sign of metastatic breast cancer: Case report (2007) Cancer Detect. Prev., 31 (6), pp. 450-452; Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R.L., Torre, L.A., Jemal, A., Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries (2018) CA Cancer J Clin., 144 (8), pp. 1941-1953; Bellanger, M., Zeinomar, N., Tehranifar, P., Terry, M.B., Are global breast cancer incidence and mortality patterns related to country-specific economic development and prevention strategies? (2018) J Glob Oncol., 4, pp. 1-16; Rivera-Franco, M.M., Leon-Rodriguez, E., Delays in breast cancer detection and treatment in developing countries (2018) Breast Cancer Basic Clin Res.; Kashiwagi, S., Onoda, N., Asano, Y., Noda, S., Kawajiri, H., Takashima, T., A rare recurrence of bilateral breast cancer in the esophagus coincidentally associated with primary gastric cancer: a case report (2014) J Med Case Rep., 8, p. 58; Rampado, S., Ruol, A., Guido, M., Zaninotto, G., Battaglia, G., Costantini, M., Mediastinal carcinosis involving the esophagus in breast cancer: The “breast-esophagus” syndrome: report on 25 cases and guidelines for diagnosis and treatment (2007) Ann Surg., 246 (2), pp. 316-322; Martin, T.J., Horner’s syndrome: a clinical review (2018) ACS Chem Neurosci., 9, pp. 177-186; Tjalma, W.A.A., Horner’s syndrome: an ominous sign in breast cancer (2006) Eur J Obstet Gynecol Reprod Biol., 126 (2), pp. 270-271; Vitale, M.G., Riccardi, F., Carrillo, G., Trunfio, M., Mocerino, C., Minelli, S., Horner’s syndrome: an unusual presentation of metastatic disease in breast cancer (2015) Int J Immunopathol Pharmacol., 28 (4), pp. 557-561; Park, S., Kim, T.S., Kim, S.K., Unusual Horner’s syndrome in recurrent breast cancer: evaluation using 18F-FDG PET/CT (2017) Nucl Med Mol Imaging., 51, pp. 93-96; Sobel, J.M., Lai, R., Mallery, S., Levy, M.J., Wiersema, M.J., Greenwald, B.D., The utility of EUS-guided FNA in the diagnosis of metastatic breast cancer to the esophagus and the mediastinum (2005) Gastrointest Endosc., 61 (3), pp. 416-420; Anwar, S.L., Raharjo, C.A., Herviastuti, R., Dwianingsih, E.K., Setyoheriyanto, D., Avanti, W.S., Pathological profiles and clinical management challenges of breast cancer emerging in young women in Indonesia: a hospital-based study (2019) BMC Womens Health., 19 (1), p. 28; De Melo, G.D., Gonzalez-Angulo, A.M., Lei, X., Theriault, R.L., Giordano, S.H., Valero, V., Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer (2014) J Clin Oncol., 32 (8), pp. 735-744; Anwar, S.L., Tampubolon, G., Van Hemelrijck, M., Hutajulu, S.H., Watkins, J., Wulaningsih, W., Determinants of cancer screening awareness and participation among Indonesian women (2018) BMC Cancer., 18 (1), p. 208; Maghous, A., Rais, F., Ahid, S., Benhmidou, N., Bellahamou, K., Loughlimi, H., Factors influencing diagnosis delay of advanced breast cancer in Moroccan women (2016) BMC Cancer., 16, p. 356; Anwar, S.L., Dwianingsih, E.K., Avanti, W.S., Choridah, L., Aryandono, T., Aggressive behavior of Her-2 positive colloid breast carcinoma: a case report in a metastatic breast cancer (2020) Ann Med Surg., 52, pp. 48-52

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