Metastatic Invasive Lobular Breast CancerPresenting Clinically with Esophageal Dysphagia

Intra-abdominal metastases of invasive lobular breast cancer (ILBC) may be insidious. We report a case of metastaticILBC that presented with dysphagia within weeks of a negative mammogram and before the development of intra-abdominalsymptoms.Case. A 70-year-old female developed esophageal dysphagia. She underwent EGD which showed a short segment ofstricture of the distal esophagus without significant mucosal changes. Biopsy was unremarkable and patient underwent loweresophageal sphincter (LES) dilation. Severe progressive dysphagia led to esophageal impaction and three LES dilatations. CT scanshowed bilateral pleural effusions, more prominent on right side, and ascites. The pleural effusions were transudative. Repeat EGDwith biopsy showed lymphocytic esophagitis, and she was started on swallowed fluticasone. Abdominal ultrasound with Dopplershowed that the main portal vein had atypical turbulent flow that was felt to possibly be due to retroperitoneal process. Thepatient underwent diagnostic laparoscopy which revealed diffuse punctate lesions on the peritoneum. Pathology was consistentwith metastatic ILBC.Conclusion. Dysphagia in the setting of peritoneal carcinomatosis from metastatic ILBC is a rare finding. Thecase highlights the importance of metastatic ILBC as a differential diagnosis for female patients with progressive dysphagia andassociated ascites or pleural effusions