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Diagnostic challenge in silent metastatic invasive breast carcinoma: dysphagia as the only symptom
  1. Dalilah Diyana Alfian Sulai1,
  2. Theevashini Krishnasamy2 and
  3. Nik Ritza Kosai Nik Mahmood1
  1. 1Department of Surgery, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
  2. 2Department of Surgery, Universiti Teknologi MARA Fakulti Perubatan Kampus Sungai Buloh, Sungai Buloh, Malaysia
  1. Correspondence to Dr Dalilah Diyana Alfian Sulai; ddiyana13{at}


Metastatic cancer to the oesophagus is rare. Most cases are diagnosed at autopsy or surgery. The breast is the most common organ bearing a primary tumour. Metastatic oesophageal tumours are nearly always located in the submucosal layer with normal benign-looking mucosa, rendering tissue diagnosis difficult. In the absence of breast-related symptoms, the diagnosis of oesophageal metastasis from breast primary would be very challenging. We report a case of a 50 year-old woman, who was referred to our centre for a second opinion after she was offered an esophagectomy for a suspected oesophageal carcinoma. She presented solely with dysphagia and weight loss. Multiple investigations were performed to investigate her dysphagia which eventually led to the diagnosis of metastatic breast cancer with oesophageal involvement. She underwent excision of right breast invasive lobular carcinoma with axillary dissection. She completed her adjuvant chemoradiotherapy and currently on daily dose of tamoxifen, whereby her dysphagia has dramatically improved.

  • cancer intervention
  • gastrointestinal surgery
  • breast surgery
  • oesophagus
  • breast cancer

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  • Contributors DDAS helped in collecting information, following up on the patient and case report writing. TK was involved in supervising the progression of the case report and contributing the idea in the case report write-up. NRK helped in contributing the idea in the case report write-up, following up on the patient and case report correction.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.