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A Rare Manifestation of Metastatic Breast Cancer: Cervical Esophageal Stenosis with Oropharyngeal Dysphagia Decades After Primary Treatment Made Gede Krisna Rendra Kawisana; I Wayan Sucipta; I Putu Santhi Dewantara
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.767

Esophageal metastasis from breast cancer is an infrequent occurrence, with cervical esophageal involvement being exceptionally rare. Presentation with oropharyngeal dysphagia, particularly decades after primary breast cancer treatment, poses a significant diagnostic challenge. This report details such a case, emphasizing the clinical course and diagnostic complexities. A 60-year-old female, with a history of primary breast cancer treated approximately two decades prior and subsequent treatment for a locoregional recurrence with surgery, chemotherapy, and radiotherapy in 2019, presented with progressive oropharyngeal dysphagia and aspiration over three months. Initial Fiberoptic Endoscopic Evaluation of Swallowing (FEES) suggested upper esophageal pathology with stenosis and extraluminal mass compression at the introitus esophagus. Esophagoscopy confirmed a high cervical esophageal stenosis impassable with the scope. Computed Tomography (CT) of the neck revealed a large heterogeneous solid mass at the C6-Th2 level, encasing the trachea and causing severe cervical esophageal stenosis with suspected wall infiltration, along with widespread metastatic disease including pulmonary and osseous metastases. In conclusion, this case highlights the critical importance of maintaining a high index of suspicion for metastatic breast cancer in patients presenting with new-onset oropharyngeal or esophageal dysphagia, even many years after their initial cancer diagnosis and treatment. Cervical esophageal metastasis, though rare, should be considered in the differential diagnosis. A multidisciplinary approach and comprehensive diagnostic evaluation, including advanced imaging, are paramount for accurate diagnosis and guiding appropriate palliative management.

Feasibility of Facial Nerve Preservation in Locally Advanced Parotid Squamous Cell Carcinoma Following Extended Neoadjuvant Chemotherapy: A Case Report Janris Sitompul; I Gde Ardika Nuaba; I Dewa Gede Arta Eka Putra; I Wayan Sucipta; I Putu Santhi Dewantara
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1554

Background: Primary squamous cell carcinoma (SCC) of the parotid gland is a rare, aggressive malignancy often requiring radical parotidectomy with facial nerve sacrifice, particularly in T4b stage disease. The utility of neoadjuvant chemotherapy (NACT) in downstaging these tumors to facilitate functional nerve preservation remains controversial and under-reported in the literature. Case presentation: A 58-year-old male presented with a fixed, rapidly enlarging left preauricular mass classified as cT4bN2M0 (Stage IVA). The tumor involved the sternocleidomastoid muscle and encased the external carotid artery. Following a multidisciplinary tumor board decision, the patient underwent an extended course of six cycles of Paclitaxel and Carboplatin. The tumor exhibited a partial clinical response and significant central necrosis on imaging. Subsequently, a total parotidectomy was performed. Despite intraoperative fragility and adherence to deep vascular structures, the main trunk and primary divisions of the facial nerve were anatomically and functionally preserved. Histopathology confirmed high-grade SCC with perineural invasion limited to the distal excised branches, achieving clear margins. The patient received 66 Gy of adjuvant radiotherapy. At the 18-month follow-up, the patient remains disease-free with House-Brackmann Grade I facial function. Conclusion: Long-term facial nerve preservation is feasible in selected cases of locally advanced parotid SCC using a multimodal approach. Extended NACT may induce tumor necrosis and facilitate dissection along the neuro-vascular interface, provided that perineural invasion does not involve the main nerve trunk.

Feasibility of Facial Nerve Preservation in Locally Advanced Parotid Squamous Cell Carcinoma Following Extended Neoadjuvant Chemotherapy: A Case Report Janris Sitompul; I Gde Ardika Nuaba; I Dewa Gede Arta Eka Putra; I Wayan Sucipta; I Putu Santhi Dewantara
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1554

Background: Primary squamous cell carcinoma (SCC) of the parotid gland is a rare, aggressive malignancy often requiring radical parotidectomy with facial nerve sacrifice, particularly in T4b stage disease. The utility of neoadjuvant chemotherapy (NACT) in downstaging these tumors to facilitate functional nerve preservation remains controversial and under-reported in the literature. Case presentation: A 58-year-old male presented with a fixed, rapidly enlarging left preauricular mass classified as cT4bN2M0 (Stage IVA). The tumor involved the sternocleidomastoid muscle and encased the external carotid artery. Following a multidisciplinary tumor board decision, the patient underwent an extended course of six cycles of Paclitaxel and Carboplatin. The tumor exhibited a partial clinical response and significant central necrosis on imaging. Subsequently, a total parotidectomy was performed. Despite intraoperative fragility and adherence to deep vascular structures, the main trunk and primary divisions of the facial nerve were anatomically and functionally preserved. Histopathology confirmed high-grade SCC with perineural invasion limited to the distal excised branches, achieving clear margins. The patient received 66 Gy of adjuvant radiotherapy. At the 18-month follow-up, the patient remains disease-free with House-Brackmann Grade I facial function. Conclusion: Long-term facial nerve preservation is feasible in selected cases of locally advanced parotid SCC using a multimodal approach. Extended NACT may induce tumor necrosis and facilitate dissection along the neuro-vascular interface, provided that perineural invasion does not involve the main nerve trunk.

Bronchoscopic Resolution of Refractory Atelectasis in a Toddler with Polymicrobial MDR Pneumonia: A Case Report I Wayan Sucipta; Eka Putra Setiawan; Komang Andi Dwi Saputra; Freddy Stanza Purba
Archives of The Medicine and Case Reports Vol. 7 No. 1 (2026): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v7i1.840

Pediatric acute respiratory distress syndrome (PARDS) complicated by ventilator-associated pneumonia (VAP) poses significant management challenges, particularly when caused by multidrug-resistant organisms such as Stenotrophomonas maltophilia and Pseudomonas aeruginosa. A frequent and deleterious complication is plate-like atelectasis, which may prove refractory to conservative management due to anatomical constraints in the pediatric airway and biofilm formation. A 23-month-old male presented with severe PARDS and polymicrobial VAP. Despite extubation to High-Flow Nasal Cannula (HFNC), the patient developed persistent right upper lobe plate-like atelectasis refractory to aggressive physiotherapy and targeted antibiotic therapy with Levofloxacin and Ceftazidime for 21 days. On Day 75 of illness, a flexible bronchoscopy was performed. Intraoperative findings revealed hyperemic mucosa without macroscopic mucus plugging. However, the procedure, involving saline lavage and suctioning, resulted in immediate recruitment. Within 24 hours, the respiratory rate decreased from 45 to 24 breaths per minute, and the SpO2/FiO2 ratio improved significantly from 185 to 310, allowing weaning from respiratory support. In conclusion, in toddlers with multidrug-resistant VAP, atelectasis may persist due to biofilm-mediated micro-obstruction rather than macroscopic plugging. Flexible bronchoscopy is a safe and effective therapeutic adjunct in these cases, facilitating distal airway recruitment and breaking the cycle of chronic infection.

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