A 68-year-old man presented with progressive dysphagia of 6 months duration, initially against solid foods and subsequently liquids, with loss of about 10 kg of weight.
The patient is a retired farmer, drinker of about 100 g alcohol/day and smoker 20 cigarettes/day, up to 3 years ago.
She had been diagnosed with Madelung's disease for 10 years and ductal adenocarcinoma affecting the right breast 10 (pT4N1Mx) for 3 years, with modified radical mastectomy and lymphadenectomy 17
She was treated with polychemotherapy and radiotherapy after surgery and subsequently maintenance oral tamoxifen was indicated.
She had no other relevant personal history or family history of oncological diseases.
On physical examination, the presence of symmetrical recesses in the cervical region with buffalo neck appearance and a scar from right mastectomy without other alterations was noteworthy.
The hemogram showed mild normocytic normochromic anemia and the complete biochemistry that included liver enzymes showed no significant alterations.
A Pathogram showing an irregular and spiculated stricture of the distal esophagus was performed, with mucosal breakdown and prestenotic dilatation, compatible with esophageal neoplasia.
Gastroscopy confirmed the presence of an ulcerated stricture of the distal esophagus that prevented the placement of the endet to the stomach and allowed biopsy which was compatible with moderately poorly differentiated adenocarcinoma of the esophagus.
The cervicothoracic TAC showed multiple necks on both sides of the neck, both in the anterior triangle and posterior triangle, in front of the gentlemastoid muscle.
There were no laterocervical adenopathies, but a dilated esophagus with a concentric mass in the distal esophagus producing a narrowing of the light.
Abdominal ultrasound detected multiple focal hypoechogenic lesions of different sizes, located in both lobes, suggestive of liver metastases, without the presence of free fluid.
The patient underwent an esophageal stent and was waiting for liver FNA to try to clarify the origin of the breast or esophageal focal liver lesions and decide the type of chemotherapy.
However, she presented several episodes of emphysema and deterioration of her general condition, which contraindicated the administration of chemotherapy, performing a palliative symptomatic treatment.
The patient finally died due to massive emphysema, one month after the diagnosis of esophageal neoplasia.
