The maximum number of node retrieval in axillary lymph node dissection in breast cancer patient (84/84); high nodal burden in breast cancer female patient: a case report and review of literature

Mahmoud H. Khalil; Ragab A. Sharif; Neveen Tahoun; Ahmed A. Shehata

doi:10.18203/2349-2902.isj20253033

Authors

Mahmoud H. Khalil Department Surgical Oncology, Damanhur Cancer Centre, Specialized Medical Centres, Egypt
Ragab A. Sharif Department Surgical Oncology, Damanhur Cancer Centre, Specialized Medical Centres, Egypt
Neveen Tahoun Department Histopathology, National Cancer Institute, Cairo University, Egypt
Ahmed A. Shehata Department Histopathology, National Cancer Institute, Cairo University, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20253033

Keywords:

Breast, Axilla, Cancer, Clearance, Dissection, Lymph node harvest, Lymph node retrieval

Abstract

We describe the case of a 41 years old female presented with right breast retro areolar painless hard mass accompanied by nipple retraction. After initial clinical assessment, further clinical radiological investigations, bilateral sonomamography imaging showed an ill-defined focal hypo echoic heterogenicity at the retro areolar region measures about 40×26 mm. Another two ill-defined hypo echoic soft tissue masses at upper inner quadrant measures about 17×16 mm and 13×11 mm. With enlarged right axillary lymph node about 20 mm in size, thickened cortex and still preserved hilum (BIRAD Ⅴ lesions). The diagnostic image guided multiple core biopsies confirmed the multicentric invasive breast cancer and molecular subtyping as Luminal B breast cancer stage Ⅱb. Whole body computed tomography (CT) as a Metastatic work was free. After the discussion among the Breast cancer Multi-disciplinary team (MDT) members and the patient, the final decision was to do surgery first in the form of right modified radical mastectomy respecting the patient desire for this choice loco regional control first - then to continue her adjuvant treatment according to the final histopathological reporting. The surprise is the unexpected this extreme number of axillary lymph nodes retrieval (84/84) after the final histopathological examination of the specimen. We did not find this extreme number of axillary lymph nodes retrieval "84" before in the literature at all regarding breast cancer management by ALND.

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References

Somner JE, Dixon JM, Thomas JS. Node retrieval in axillary lymph node dissections: recommendations for minimum numbers to be confident about node negative status. J Clin Pathol. 2004;57(8):845-8. DOI: https://doi.org/10.1136/jcp.2003.015560

Bonadonna G, Hortobagyi GN, Gianni AM. Textbook of breast cancer, a clinical guide to therapy, 2nd ed. London: Martin Dunitz. 2001;2:986.

Veronesi U, Galimberti V, Zurrida S. Prognostic significance of number and level of axillary nodal metastases in breast cancer. Breast. 1993;2:224–8. DOI: https://doi.org/10.1016/0960-9776(93)90004-Y

Bembenek A, Schlag PM. Lymph-node dissection in breast cancer. Langenbecks Arch Surg. 2000;385(4):236-45. DOI: https://doi.org/10.1007/s004239900055

Maunsell E, Brisson J, Deshenes l. Arm problems and psychological distress after surgery for breast cancer. Can J Surg. 1993;36:315–20.

Singletary SE. Management of the axilla in early stage breast cancer. In: Perry MC, ed. American Society of Clinical Oncology educational book. Alexandria, VA: American Soc Clin Oncol. 1998;2:132–41.

Brackstone M, Baldassarre FG, Perera FE, Cil T, Chavez Mac Gregor M, Dayes IS, et al. Management of the Axilla in Early-Stage Breast Cancer: Ontario Health (Cancer Care Ontario) and ASCO Guideline. J Clin Oncol. 2021;39(27):3056-82. DOI: https://doi.org/10.1200/JCO.21.00934

Fitzgibbons PL, Page DL, Weaver D. Prognostic factors in breast cancer, College of American Pathologists consensus statement 1999. Arch Pathol Lab Med 2000;124:966–78. DOI: https://doi.org/10.5858/2000-124-0966-PFIBC

Ahlgren J, Holmberg L, Bergh J. Five node biopsy of the axilla: an alternative to axillary dissection of levels I–II in operable breast cancer. Eur J Surg Oncol. 2002;28:97–102. DOI: https://doi.org/10.1053/ejso.2001.1228

Millet A, Fuster CA, Lluch A, Dirbas F. Axillary surgery in breast cancer patients. Clin Transl Oncol. 2007;9(8):513-20. DOI: https://doi.org/10.1007/s12094-007-0095-3

Saha S, Farrar WB, Young DC. Variation in axillary node dissection influences the degree of nodal involvement in breast cancer patients. J Surg Oncol 2000;73:134–7. DOI: https://doi.org/10.1002/(SICI)1096-9098(200003)73:3<134::AID-JSO4>3.0.CO;2-F

Sávolt A, Musonda P, Mátrai Z, Polgár C, Rényi-Vámos F, Rubovszky G, et al. Az axilla optimális kezelése pozitív őrszemnyirokcsomó esetén korai invazív emlőrákban. Az OTOASOR vizsgálat előzetes eredményei Optimal treatment of the axilla after positive sentinel lymph node biopsy in early invasive breast cancer. Early results of the OTOASOR. Orv Hetil. 2013;154(49):1934-42. DOI: https://doi.org/10.1556/OH.2013.29765

Nemoto T, Dao TL. Is modified radical mastectomy adequate for axillary lymph node dissection. Ann Surg. 1975;182(6):722-3. DOI: https://doi.org/10.1097/00000658-197512000-00011