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Successfully treated advanced esophageal cancer with left axillary lymph node metastasis and synchronous right breast cancer: a case report

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ABSTRACT

The incidence of double cancer of the esophagus and breast is rare, and axillary lymph node metastasis (ALM) in esophageal cancer is also very rare. We report a case of advanced esophageal cancer with left ALM and synchronous right breast cancer. A 64-year-old woman was admitted to our hospital with dysphagia. The clinical diagnosis was esophageal cancer (T3N0M1 stage IV) and right breast cancer (T1cN0M0 stage I). She was initially treated with triple chemotherapy with docetaxel, cisplatin, and 5-fluorouracil. The primary lesion in the esophagus achieved almost complete response as assessed by esophageal endoscopy. A computed tomography scan showed that the left ALM reduced in size and that stable disease was achieved for the right breast cancer. She underwent partial mastectomy of the right breast and bilateral axillary lymph node dissection. The histopathological diagnosis of the breast cancer was T1cN1M0 stage IIA. The lymph nodes from the left axilla contained metastatic cells from the squamous cell carcinoma of the esophagus. Complete response was achieved for the primary lesion in the esophagus following chemoradiotherapy (CRT), and the patient has been relapse free 2 years after treatment. Thus, we report the successful treatment of synchronous double cancers of the esophagus with left ALM and right breast by combination therapy with chemotherapy, CRT, and surgery.

No MeSH data available.


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Positron emission tomography–computed tomography (PET–CT) findings. a PET–CT scan showing accumulation in the middle esophagus (standardized uptake value [SUV] max of 12.6). b PET–CT scan after four courses of chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) showing the disappearance of the accumulation in the primary tumor. c PET–CT scan showing accumulation in the left axillary lymph node (SUV max of 3.6). d PET–CT scan after four courses of DCF treatment showing the disappearance of the accumulation in the left axillary lymph node
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Fig3: Positron emission tomography–computed tomography (PET–CT) findings. a PET–CT scan showing accumulation in the middle esophagus (standardized uptake value [SUV] max of 12.6). b PET–CT scan after four courses of chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) showing the disappearance of the accumulation in the primary tumor. c PET–CT scan showing accumulation in the left axillary lymph node (SUV max of 3.6). d PET–CT scan after four courses of DCF treatment showing the disappearance of the accumulation in the left axillary lymph node

Mentions: Fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET–CT) scan showed hypermetabolic lesions in the thoracic esophagus [standardized uptake value (SUV) max of 12.6], right breast (SUV max of 2.0), left axillary lymph nodes (SUV max of 3.6; Fig. 3a, c), and right supraclavicular region (SUV max of 3.4), which was not detected in the CT scan. FDG accumulation was not observed in the other nodes, including the lymph nodes detected in the chest and abdominal CT. Ultrasonographic examination revealed a solid mass measuring 1.0 cm × 0.9 cm in the upper outer quadrant of the right breast. Core needle biopsy from the tumor in the right breast revealed a scirrhous carcinoma, a subtype of invasive ductal carcinoma, that was positive for estrogen receptors (ERs) but negative for progesterone receptors (PgRs) and HER2/Neu. Fine-needle aspiration cytology from the left ALM did not provide definitive diagnosis of cancer cells. The clinical diagnosis was esophageal cancer (T3N0M1 stage IV according to the 7th edition of the Union for International Cancer Control classification) and synchronous right breast cancer (T1cN0M0 stage I). She was treated initially by triple chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) as an induction chemotherapy for the esophageal cancer, with four courses over 4 weeks of docetaxel (60 mg/m2 on day 1), cisplatin (80 mg/m2 on day 1), and 5-fluorouracil (800 mg/m2 on days 1–5).Fig. 3


Successfully treated advanced esophageal cancer with left axillary lymph node metastasis and synchronous right breast cancer: a case report
Positron emission tomography–computed tomography (PET–CT) findings. a PET–CT scan showing accumulation in the middle esophagus (standardized uptake value [SUV] max of 12.6). b PET–CT scan after four courses of chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) showing the disappearance of the accumulation in the primary tumor. c PET–CT scan showing accumulation in the left axillary lymph node (SUV max of 3.6). d PET–CT scan after four courses of DCF treatment showing the disappearance of the accumulation in the left axillary lymph node
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Fig3: Positron emission tomography–computed tomography (PET–CT) findings. a PET–CT scan showing accumulation in the middle esophagus (standardized uptake value [SUV] max of 12.6). b PET–CT scan after four courses of chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) showing the disappearance of the accumulation in the primary tumor. c PET–CT scan showing accumulation in the left axillary lymph node (SUV max of 3.6). d PET–CT scan after four courses of DCF treatment showing the disappearance of the accumulation in the left axillary lymph node
Mentions: Fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET–CT) scan showed hypermetabolic lesions in the thoracic esophagus [standardized uptake value (SUV) max of 12.6], right breast (SUV max of 2.0), left axillary lymph nodes (SUV max of 3.6; Fig. 3a, c), and right supraclavicular region (SUV max of 3.4), which was not detected in the CT scan. FDG accumulation was not observed in the other nodes, including the lymph nodes detected in the chest and abdominal CT. Ultrasonographic examination revealed a solid mass measuring 1.0 cm × 0.9 cm in the upper outer quadrant of the right breast. Core needle biopsy from the tumor in the right breast revealed a scirrhous carcinoma, a subtype of invasive ductal carcinoma, that was positive for estrogen receptors (ERs) but negative for progesterone receptors (PgRs) and HER2/Neu. Fine-needle aspiration cytology from the left ALM did not provide definitive diagnosis of cancer cells. The clinical diagnosis was esophageal cancer (T3N0M1 stage IV according to the 7th edition of the Union for International Cancer Control classification) and synchronous right breast cancer (T1cN0M0 stage I). She was treated initially by triple chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) as an induction chemotherapy for the esophageal cancer, with four courses over 4 weeks of docetaxel (60 mg/m2 on day 1), cisplatin (80 mg/m2 on day 1), and 5-fluorouracil (800 mg/m2 on days 1–5).Fig. 3

View Article: PubMed Central

ABSTRACT

The incidence of double cancer of the esophagus and breast is rare, and axillary lymph node metastasis (ALM) in esophageal cancer is also very rare. We report a case of advanced esophageal cancer with left ALM and synchronous right breast cancer. A 64-year-old woman was admitted to our hospital with dysphagia. The clinical diagnosis was esophageal cancer (T3N0M1 stage IV) and right breast cancer (T1cN0M0 stage I). She was initially treated with triple chemotherapy with docetaxel, cisplatin, and 5-fluorouracil. The primary lesion in the esophagus achieved almost complete response as assessed by esophageal endoscopy. A computed tomography scan showed that the left ALM reduced in size and that stable disease was achieved for the right breast cancer. She underwent partial mastectomy of the right breast and bilateral axillary lymph node dissection. The histopathological diagnosis of the breast cancer was T1cN1M0 stage IIA. The lymph nodes from the left axilla contained metastatic cells from the squamous cell carcinoma of the esophagus. Complete response was achieved for the primary lesion in the esophagus following chemoradiotherapy (CRT), and the patient has been relapse free 2 years after treatment. Thus, we report the successful treatment of synchronous double cancers of the esophagus with left ALM and right breast by combination therapy with chemotherapy, CRT, and surgery.

No MeSH data available.


Related in: MedlinePlus