Axillary Reverse Lymphatic Mapping in the Treatment of Axillary Accessory Breast Cancer: A Case Report and Review of Management.

European journal of breast health Pub Date : 2021-12-30 eCollection Date: 2022-01-01 DOI:10.4274/ejbh.galenos.2021.2021-7-3
Orli Friedman-Eldar, Siarhei Melnikau, Youley Tjendra, Eli Avisar
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引用次数: 2

Abstract

Accessory breast tissue is a rare aberration of normal breast development, that presents most commonly in the axilla. Similar to normal breast tissue, it can undergo physiologic and pathologic changes, including malignant transformation. We report a rare case of accessory breast cancer, treated with surgical resection and axillary reverse mapping (ARM), and review current literature focusing on management. We report a 68-year-old female with a history of left breast cancer treated with lumpectomy and axillary dissection, who later developed in-breast recurrence treated with re-lumpectomy and sentinel node biopsy which mapped at the contralateral (right) axilla, but was negative. Two years later screening imaging revealed right axillary tail focal asymmetry with two spiculated masses. Core biopsy showed invasive ductal carcinoma (IDC), and histologic examination of the biopsy could not determine whether this represents a new primary breast cancer or axillary metastasis from the contralateral site. She underwent lumpectomy of the two masses and sentinel node biopsy. During surgery, the masses were identified in the axilla itself, rather than the axillary tail. Final pathology revealed IDC, pT1N0(sn), and extensive ductal carcinoma in situ (DCIS). Due to positive margins, she underwent re-lumpectomy with ARM. Final pathology revealed residual DCIS with negative new margins. The patient was referred for adjuvant radiotherapy. Accessory axillary breast tissue can be confused with axillary tail tissue. It is necessary for the surgeon to distinguish between them by meticulous physical examination and radiologic evaluation, as resection of axillary breast tissue may warrant reverse lymphatic mapping for lymphedema prevention.

Abstract Image

腋窝淋巴逆行造影治疗腋窝副癌一例报告及治疗回顾。
副乳腺组织是一种罕见的异常正常乳房发育,最常见于腋窝。与正常乳腺组织类似,它可以发生生理和病理变化,包括恶性转化。我们报告一例罕见的副乳腺癌,通过手术切除和腋窝反向映射(ARM)治疗,并回顾目前的文献关注管理。我们报告了一位68岁的女性患者,她曾接受乳房肿瘤切除术和腋窝清扫术治疗,后来在乳房肿瘤切除术和前哨淋巴结活检中复发,该活检在对侧(右)腋窝进行,但阴性。两年后的筛检影像显示右侧腋窝尾局灶不对称伴两个针状肿块。核心活检显示浸润性导管癌(invasive ductal carcinoma, IDC),活检的组织学检查不能确定这是新的原发性乳腺癌还是对侧腋窝转移。她接受了两个肿块的乳房肿瘤切除术和前哨淋巴结活检。在手术中,肿块被发现在腋窝本身,而不是腋窝尾。最终病理显示IDC, pT1N0(sn)和广泛导管原位癌(DCIS)。由于边缘呈阳性,她再次接受了ARM乳房肿瘤切除术。最终病理显示残余DCIS伴阴性新缘。患者接受辅助放疗。副腋窝乳腺组织可能与腋窝尾组织混淆。外科医生有必要通过细致的体格检查和放射学评估来区分它们,因为切除腋窝乳腺组织可能需要反向淋巴映射以预防淋巴水肿。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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