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Forequarter amputation for recurrent breast cancer.

Pundi KN, AlJamal YN, Ruparel RK, Farley DR - Int J Surg Case Rep (2015)

Bottom Line: Unfortunately, while she had symptomatic relief in the short-term, she had cutaneous recurrence of metastatic adenocarcinoma within 2 months of the procedure.Furthermore, among patients who had significant pain prior to surgery, all patients reported pain relief, indicating a significant palliative benefit.In the long term, these patients may still have significant psychological problems.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, United States.

No MeSH data available.


Related in: MedlinePlus

(A) Coronal MRA showing axillary recurrence of a 4.5 cm mass abutting the chest wall and axillary vein with possible involvement; (B) and (C) demonstrate the tumor in horizontal sections.
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fig0015: (A) Coronal MRA showing axillary recurrence of a 4.5 cm mass abutting the chest wall and axillary vein with possible involvement; (B) and (C) demonstrate the tumor in horizontal sections.

Mentions: With concerns radiation was no longer an option, the patient and her oncologists desired lymph node removal in hopes of analysis to devise a better chemotherapy regimen. With a full understanding that more surgery would unlikely be curative, the patient and surgeon agreed on a third axillary operation; the procedure was difficult with dense, irradiated scar tissue throughout the axilla (Fig. 2 shows the intraoperative ultrasound). The node and surrounding tissue was removed en bloc, but resection of the axillary vein and pectoralis muscle was avoided. Histologic analysis revealed poorly differentiated adenocarcinoma involving the lymph node consistent with a primary breast source. Magnetic resonance angiography (MRA) performed three months later showed an ill-defined 4.5 cm soft tissue mass in the right axilla consistent with recurrent tumor or adenopathy and possible involvement of the axillary vein and chest wall (Fig. 3). At this time there was no evidence of distant metastatic disease. In consulting with her medical team, the patient was presented the options of continuing with observation, further chemotherapy, or a forequarter amputation. In order to attempt a more aggressive solution to the issue, the patient opted for a forequarter amputation, which was successfully performed one month later. The surgery involved removal of the right arm, resection of the chest wall from ribs 2–5, wedge resection of a 1 mm right lung nodule (palpated during surgery but not seen on imaging), chest wall reconstruction, and placement of a right brachial plexus nerve catheter (Fig. 4). The total OR time was 4.5 h. Histology revealed that the axillary mass and pulmonary nodule were both consistent with poorly differentiated adenocarcinoma with a primary breast source; surgical resection margins were negative. Her postoperative course was generally uneventful save for a brief episode of atrial fibrillation. The patient was discharged on postoperative day 7 with referrals to physical therapy, occupational therapy, and amputee service, as well as deep vein thrombosis prophylaxis with acetylsalicylic acid for six weeks.


Forequarter amputation for recurrent breast cancer.

Pundi KN, AlJamal YN, Ruparel RK, Farley DR - Int J Surg Case Rep (2015)

(A) Coronal MRA showing axillary recurrence of a 4.5 cm mass abutting the chest wall and axillary vein with possible involvement; (B) and (C) demonstrate the tumor in horizontal sections.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4446684&req=5

fig0015: (A) Coronal MRA showing axillary recurrence of a 4.5 cm mass abutting the chest wall and axillary vein with possible involvement; (B) and (C) demonstrate the tumor in horizontal sections.
Mentions: With concerns radiation was no longer an option, the patient and her oncologists desired lymph node removal in hopes of analysis to devise a better chemotherapy regimen. With a full understanding that more surgery would unlikely be curative, the patient and surgeon agreed on a third axillary operation; the procedure was difficult with dense, irradiated scar tissue throughout the axilla (Fig. 2 shows the intraoperative ultrasound). The node and surrounding tissue was removed en bloc, but resection of the axillary vein and pectoralis muscle was avoided. Histologic analysis revealed poorly differentiated adenocarcinoma involving the lymph node consistent with a primary breast source. Magnetic resonance angiography (MRA) performed three months later showed an ill-defined 4.5 cm soft tissue mass in the right axilla consistent with recurrent tumor or adenopathy and possible involvement of the axillary vein and chest wall (Fig. 3). At this time there was no evidence of distant metastatic disease. In consulting with her medical team, the patient was presented the options of continuing with observation, further chemotherapy, or a forequarter amputation. In order to attempt a more aggressive solution to the issue, the patient opted for a forequarter amputation, which was successfully performed one month later. The surgery involved removal of the right arm, resection of the chest wall from ribs 2–5, wedge resection of a 1 mm right lung nodule (palpated during surgery but not seen on imaging), chest wall reconstruction, and placement of a right brachial plexus nerve catheter (Fig. 4). The total OR time was 4.5 h. Histology revealed that the axillary mass and pulmonary nodule were both consistent with poorly differentiated adenocarcinoma with a primary breast source; surgical resection margins were negative. Her postoperative course was generally uneventful save for a brief episode of atrial fibrillation. The patient was discharged on postoperative day 7 with referrals to physical therapy, occupational therapy, and amputee service, as well as deep vein thrombosis prophylaxis with acetylsalicylic acid for six weeks.

Bottom Line: Unfortunately, while she had symptomatic relief in the short-term, she had cutaneous recurrence of metastatic adenocarcinoma within 2 months of the procedure.Furthermore, among patients who had significant pain prior to surgery, all patients reported pain relief, indicating a significant palliative benefit.In the long term, these patients may still have significant psychological problems.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, United States.

No MeSH data available.


Related in: MedlinePlus