Anwar Sumadi Lukman, Avanti Widya Surya, Choridah Lina, Dwianingsih Ery Kus, Hardiyanto Herjuna, Aryandono Teguh
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.
J Med Case Rep. 2021 Apr 9;15(1):194. doi: 10.1186/s13256-021-02688-7.
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.
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.
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.
食管受累和霍纳综合征是乳腺癌远处转移的罕见表现，在诊断和治疗方面可能构成重大挑战。除了年轻女性诊断出的乳腺癌侵袭性更强外，不坚持治疗会增加远处转移的风险。
一名36岁的爪哇族女性因吞咽困难、声音嘶哑和频繁打嗝前来我院就诊。在本次入院前的6周内，患者还报告颈部和肩部有刺痛感、左侧面部无汗以及左上眼睑下垂。她之前被诊断为结核样喉炎。X线平片显示颈椎爆裂骨折和少量胸腔积液。喉镜检查显示声带弯曲，会厌谷有液体残留，颏部前屈时减少。内镜检查证实食管转移，显示管壁增厚，细胞学涂片检出导管恶性细胞阳性。该患者有乳腺癌病史，曾失访4年。
医生应考虑乳腺癌转移至食管和颈部交感神经系统的可能性，尤其是对于出现吞咽困难和霍纳综合征表现的高危女性。
