axillary metastasis
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BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Manu Vats ◽  
Lovenish Bains ◽  
Pawan Lal ◽  
Shramana Mandal

Abstract Background Gallbladder cancer is a very aggressive type of biliary tract cancer. The only curative treatment is complete surgical excision of the tumour. However, even after surgery, there is still a risk of recurrence of the cancer. Case presentation A 63-year-old gentleman presented with the complaint of a non-healing ulcer at upper abdomen for the last 1 month. He had undergone a laparoscopic cholecystectomy at a private centre 4 months ago. Investigations confirmed the diagnosis of epigastric port site metastasis from a primary from gall bladder adenocarcinoma. After undergoing completion radical cholecystectomy with wide local excision of the epigastric ulcer, he received 6 cycles of concurrent chemoradiotherapy. Eighteen months later, he presented to us with bilateral axillary swellings. Investigations confirmed isolated bilateral axillary metastasis and the patient underwent a bilateral axillary lymphadenectomy (Level 3). However, PET scan after 6 months showed widespread metastasis and the patient succumbed to the illness 1 month later. Conclusion Axillary metastasis probably occurs due to the presence of microscopic systemic metastasis at the time of development of port site metastasis. An R0 resection of the malignancy is the only viable option for effective therapy. The present case highlights the rare involvement of isolated bilateral axillary lymph nodes as a distant metastatic site with no evidence of disease in the locoregional site. However, the prognosis after metastasis remains dismal despite multiple treatment modalities.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Myung Won Song ◽  
So Yeon Ki ◽  
Hyo Soon Lim ◽  
Hyo-jae Lee ◽  
Ji Shin Lee ◽  
...  

Abstract Background Initial detection of axillary metastasis without known ipsilateral breast cancer could be a challenging diagnostic problem. Four options could be considered for the primary site of the malignancy: ipsilateral occult breast cancer, contralateral breast cancer, tumors in other distant organs, and primary axillary malignancy itself. Although breast cancer is known as the most common primary cancer of axillary metastasis, both occult breast cancer and breast cancer with contralateral axillary metastasis (CAM) are rare. Case presentation A 63-year-old woman presented with palpable right axillary metastasis, and a tiny contralateral breast cancer was detected by breast magnetic resonance imaging. No lesion was found in the ipsilateral right breast and contralateral left axillary region. Both right axillary metastasis and contralateral breast cancer were positive for estrogen receptor. The diagnostic issue was to determine whether the axillary metastasis was derived from the contralateral breast cancer or not. Right axillary dissection and left breast conserving surgery were performed. The final diagnosis was occult breast cancer that presented with axillary lymph node metastasis and early-stage synchronous contralateral breast cancer, based on clinical evidence and postoperative pathologic results. After surgery, systemic treatment and whole breast irradiation were administered. No recurrence or metastasis was observed 15 months postoperatively. Conclusion For accurate diagnosis of axillary metastasis without detectable ipsilateral breast cancer, multifaceted diagnostic approach considering clinical, radiological, and pathological evidences is required.


Author(s):  
Vandana Dialani ◽  
Basak Dogan ◽  
Katerina Dodelzon ◽  
Brian N Dontchos ◽  
Neha Modi ◽  
...  

Abstract Traditionally, patients with newly diagnosed invasive breast cancer underwent axillary US to assess for suspicious axillary lymph nodes (LNs), which were then targeted for image-guided needle biopsy to determine the presence of metastasis. Over the past decade, there has been a shift towards axillary preservation. For patients with palpable lymphadenopathy, the decision to perform axillary imaging with documentation of the number and location of abnormal LNs in preparation for image-guided LN sampling is straightforward. Since LN involvement correlates with cancer size, it is reasonable to image the axilla in patients with tumors larger than 5 cm; however, for tumors smaller than 5 cm, axillary imaging is often deferred until after the tumor molecular subtype and treatment plan are established. Over the last decade, neoadjuvant chemotherapy (NACT) is increasingly used for smaller cancers with more aggressive molecular subtypes. In most cases, detecting axillary metastasis is critical when deciding whether the patient would benefit from NACT. There is increasing evidence that abnormal axillary US findings correlates with LN metastases and reliably establishes a baseline to monitor response to NACT. Depending on hormone receptor status, practices may choose to image the axilla in the setting of clinical stage T1 and T2 cancers to evaluate nodal status and help determine further steps in care. Radiologists should understand the nuances of axillary management and the scope and challenges of LN marking techniques that significantly increase the precision of limited axillary surgery.


2021 ◽  
Vol 10 (20) ◽  
pp. 4754
Author(s):  
Hee Jun Choi ◽  
Jai Min Ryu ◽  
Byung Joo Chae ◽  
Seok Jin Nam ◽  
Jonghan Yu ◽  
...  

The purpose of this study was to evaluate pathologic lymph node metastasis in breast cancer with cytology-proven axillary metastasis. This study was designed prospectively. We performed axillary lymph node dissections (ALND) after lymphatic mapping by near-infrared (NIR) fluorescence imaging with Indocyanine Green (ICG). We evaluated 72 breast cancer patients with cytology-proven axillary metastasis by curative surgery at the Samsung Medical Center between May of 2016 and December of 2017. Among the 72 patients with cytology-proven axillary metastasis, 14 of 39 patients (35.9%) with one or two sentinel lymph nodes containing metastases were metastasized to post-sentinel lymph node. Thirteen of fourteen patients had additional non-sentinel lymph node metastases, seven of thirteen patients also had additional level II lymph node metastases, and one patient had only one additional level II lymph node metastasis. Of T1 or T2 stage patients, 10 of 33 patients (30.3%) with one or two sentinel lymph nodes containing metastases were metastasized to post-sentinel lymph node. Even in patients without SLN metastasis, 50% of the patients had at least three LN metastases, and 40% in the T1 or T2 stage patients. Sentinel lymph node biopsy without ALND might be not safe for patients with cytology-proven axillary metastasis.


2021 ◽  
Vol 8 (10) ◽  
pp. 3041
Author(s):  
Nitinkumar D. Chaudhary ◽  
Dhaval Chaudhari

Background: Sentinel lymph node biopsy (SLNB) is the gold standard for histopathological staging of early breast cancer. Combination of axillary ultrasound with fine-needle aspiration cytology (Ax US with FNAC) of suspicious lymph nodes, specificity for diagnosis of metastatic lymph nodes can be increased.Methods: This prospective study was done among 205 cases with clinically N0 axilla visited at surgical oncology department at Amrita institute of medical sciences from January 2014 to February 2017. Exclusion criteria was patients with locally advanced breast cancer, previous axillary surgery, prior breast irradiation, proven distant metastasis, inflammatory breast cancer and neo-adjuvant chemotherapy. All patients were subjected to ultrasound of breast and axilla during preoperative evaluation. Suspicious looking nodes were subjected to image guided FNAC. Benign appearing nodes or a negative FNAC, a SLNB procedure with intra-operative frozen section sentinel node (FS SN) was performed at the time of surgery.Results: Present study found sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ax US was 62.9%, 84.4%, 67.7%, 81.4% and 77.1% respectively. Sensitivity, specificity, PPV, NPV and accuracy of Ax US with FNAC was 90.0%, 100.0%, 100.0%, 83.3% and 93.3% respectively. Sensitivity, specificity, PPV, NPV and accuracy of SLNB with FS SN was 64.5%, 97.5%, 87.0%, 91.5% and 90.8% respectively.Conclusions: US guided fine-needle aspiration biopsy (FNAB) has highest specificity and sensitivity. Combining Ax US±FNAC and intra-operative FS SN in the detecting axillary metastasis very much decrease the chance of false results. The results of sonography would allow patients with sonographically positive axillae to be directed to axillary lymph node dissection (ALND). The remaining patients would be candidates for SN biopsy. 


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ivan Bièche ◽  
Florence Coussy ◽  
Rania El-Botty ◽  
Sophie Vacher ◽  
Sophie Château-Joubert ◽  
...  

AbstractMalignant adenomyoepithelioma (AME) of the breast is an exceptionally rare form of breast cancer, with a significant metastatic potential. Chemotherapy has been used in the management of advanced AME patients, however the majority of treatments are not effective. Recent studies report recurrent mutations in the HRAS Q61 hotspot in small series of AMEs, but there are no preclinical or clinical data showing H-Ras protein as a potential therapeutic target in malignant AMEs. We performed targeted sequencing of tumours’ samples from new series of 13 AMEs, including 9 benign and 4 malignant forms. Samples from the breast tumour and the matched axillary metastasis of one malignant HRAS mutated AME were engrafted and two patient-derived xenografts (PDX) were established that reproduced the typical AME morphology. The metastasis-derived PDX was treated in vivo by different chemotherapies and a combination of MEK and BRAF inhibitors (trametinib and dabrafenib). All malignant AMEs presented a recurrent mutation in the HRAS G13R or G12S hotspot. Mutation of PIK3CA were found in both benign and malignant AMEs, while AKT1 mutations were restricted to benign AMEs. Treatment of the PDX by the MEK inhibitor trametinib, resulted in a marked anti-tumor activity, in contrast to the BRAF inhibitor and the different chemotherapies that were ineffective. Overall, these findings further expand on the genetic features of AMEs and suggest that patients carrying advanced HRAS-mutated AMEs could potentially be treated with MEK inhibitors.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Abdulrahman ◽  
D Johnston ◽  
S Diab ◽  
B Skelly

Abstract Mammary carcinoma with Osteoclast Giant Cells (OGCs) is a rare tumour. Although several cases were reported, the significance of this histological finding remains incompletely understood. OGCs may occur in several types of breast carcinoma with different epidemiological characteristics but, in association with pregnancy, OGCs has not been reported to date. Here we report a case 37-year-old presenting with a symptomatic breast lump in pregnancy that has been confirmed clinically and radiologically. Microscopic examination of biopsies and surgical specimens showed OGCs accompanying invasive ductal carcinoma with no evidence of axillary metastasis. Immunohistochemical analysis revealed tumour cells to be positive for oestrogen, and progesterone receptors, with human epidermal growth factor negative status (ER6, PR8, HER2 negative). This is the first case of OGCs during pregnancy to be reported, to our best of knowledge, following a search of the literature published in English language.


2021 ◽  
Author(s):  
Manu Vats ◽  
Lovenish Bains ◽  
Pawan Lal ◽  
Shramana Mandal

Abstract Background: Gallbladder cancer is a very aggressive type of biliary tract cancer. The only curative treatment is complete surgical excision of the tumour. However, even after surgery, there is still a risk of recurrence of the cancer.Case summary: A 63-year-old gentleman presented with the complaint of a non-healing ulcer at epigastrium for the last 1 month, after having undergone a laparoscopic cholecystectomy at a private centre 4 months ago. Investigations confirmed the diagnosis of epigastric port site metastasis from a primary from gall bladder adenocarcinoma. After undergoing completion radical cholecystectomy with wide local excision of the epigastric ulcer, he received 6 cycles of concurrent chemoradiotherapy. Eighteen months later, he presented to us with bilateral axillary swellings. Investigations confirmed bilateral axillary metastasis. He then underwent bilateral axillary lymphadenectomy (Level 3). However, PET scan after 6 months showed widespread metastasis and the patient succumbed to the illness 1 month later.Conclusion: Axillary metastasis probably occurs due to the presence of microscopic systemic metastasis at the time of development of port site metastasis. An R0 resection of the malignancy is the only viable option for effective therapy. The present case highlights the rare involvement of bilateral axillary lymph nodes as the first distant metastatic site with no evidence of disease in the locoregional site. However, the prognosis after metastasis remains dismal despite multiple treatment modalities.


Author(s):  
Lauren M. Postlewait ◽  
Mediget Teshome ◽  
Taiwo Adesoye ◽  
Sarah M. DeSnyder ◽  
Bora Lim ◽  
...  

Author(s):  
Lauren M. Postlewait ◽  
Mediget Teshome ◽  
Taiwo Adesoye ◽  
Sarah M. DeSnyder ◽  
Bora Lim ◽  
...  

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