Thorax
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
A 52-year-old woman is diagnosed with breast cancer. The team providing her health care is concerned about the possible spread of malignant cells via lymphatic pathways. Which the following lymph nodes are most likely to become involved in the spread of the pathology?Inguinal lymph nodes.Parasternal lymph nodes.Axillary lymph nodes.Epitrochlear lymph nodes.Cysterna chyli.
Mammography and Interventional Breast Procedures
Raymond Taillefer, Iraj Khalkhali, Alan D. Waxman, Hans J. Biersack in Radionuclide Imaging of the Breast, 2021
Lymphatic drainage of the breast is primarily through the axillary lymph nodes. Attempts to stage the axilla by mammography have been unsuccessful. Mammography with dedicated units generally provides a limited view of the axilla. The lower axillary lymph nodes can be seen on mediolateral oblique views, but mammography is relatively inaccurate in determining their status [59]. Normal axillary lymph nodes are <2 cm in size and have a fairly typical hilar notch or lucent center. When replaced by fat, axillary lymph nodes may become extremely large, but the lucent fat is obvious. Lymph nodes without central lucency that are >1.5 to 2 cm in size should be considered abnormal (Fig. 28) [47]. These are nonspecific and may be secondary to reactive hyperplasia. Furthermore, axillary lymph nodes may appear normal by mammography and still contain tumor. Surgical sampling is the most accurate method of assessing the involvement of axillary lymph nodes.
Integrative hyperthermia treatments for different types of cancer
Clifford L. K. Pang, Kaiman Lee in Hyperthermia in Oncology, 2015
Breast mass is the most common manifestation of breast cancer. The symptom of nipple discharge mostly means benign change. But patients more than 50 years old with unilateral nipple discharge should be alerted to the possibility of breast cancer. Nipple retraction, nipple itching, scaling, erosion, ulceration, scab, and eczema-like changes are often clinical manifestations of mammary Paget’s disease. Some patients present breast skin and contour changes. For example, when the cancer invades the Cooper ligament of the skin a “dimple syndrome” can be formed, cancer cells blocking subcutaneous lymphatic capillaries can result in skin edema, and depressions at the hair follicles can form the “orange peel” syndrome. When the skin is widely invaded, many hard nodules or small cords are formed in the epidermis or even integrated into pieces. If lesions extend to the back and to contralateral chest wall, breathing can be restricted and corset cancer can be formed. Inflammatory breast cancer can present significantly enlarged breasts with skin congestion, redness, and swelling and with increased local skin temperature. In addition, advanced breast cancer can present skin ulceration and form cancerous ulcers. Some patients present with swollen lymph nodes: the ipsilateral axillary lymph nodes can undergo swelling. Advanced breast cancer can transfer to contralateral axillary lymph node metastasis and cause swelling; moreover, the ipsilateral and contralateral supraclavicular lymph nodes are palpable in some cases.
A multicentre retrospective study of primary breast diffuse large B-cell and high-grade B-cell lymphoma treatment strategies and survival
Published in Hematology, 2020
Tingting Zhang, Hongguo Zhao, Zhongguang Cui, Haicang Xu, Xiaodan Liu, Ying Wu, Ying Li, Shuxiang Sun, Peijun Wang, Yanli Wang, Xue Shi
Twenty-nine PB-DLBCL patients were eligible for our study. The basic characteristics of these patients are shown in Table 1. At a median follow-up of 2.8 years (range, 0.4–7.9 years), none were lost to follow-up. The median age was 56 years (range, 21–79 years). Twenty-six patients (89.7%) presented with painless unilateral breast masses. The left breast was more likely to be involved than the right breast (69.0% vs 20.7%). The median tumour size was 3.4 cm (range, 1.2–12 cm), with 8 patients having a tumour of more than 5 cm and 1 patient having a tumour of more than 10 cm. A total of 11 patients (37.9%) had axillary lymph node involvement at initial diagnosis. Of the 29 patients, 86.7% had non-germinal centre (non-GCB)-type tumours. Among the 29 PB-DLBCL patients with available information on Ann Arbor staging, 7 patients (24.1%) were stage IE, with 10 patients (34.5%) being stage IIE and 12 patients (41.4%) being stage IV. Among the PB-DLBCL cohort, 13 patients were categorized as having double expression, and 9 patients were categorized as having triple expression. Seven PB-HGBCL patients were enrolled in our study. Among them, the median age was 57 years (range, 52–82 years). The median tumour size was 3.2 cm (range, 2.1–6.3 cm), with two patients having tumours of more than 5 cm in size. All PB-HGBCL patients were in the high-intermediate and high-risk groups. Considering the limited number of PB-HGBCL patients, we mainly analysed the clinical data of PB-DLBCL patients. Seven PB-DLBCL patients and five PB-HGBCL patients died before the last follow-up on December 1, 2018.
Can a machine-learning model improve the prediction of nodal stage after a positive sentinel lymph node biopsy in breast cancer?
Published in Acta Oncologica, 2020
V. Madekivi, P. Boström, A. Karlsson, R. Aaltonen, E. Salminen
Axillary lymph node status is an important prognostic factor in disease staging and treatment planning after surgery for breast cancer. This study shows that high nodal burden in early breast cancer could be predicted with an appropriate predictive model as seen in other studies before [4–11]. It is complementary to the recent randomized clinical trials that have changed the look on axillary nodal clearance [1–3,28]. The variables associated with higher nodal burden were similar to other studies: tumor size, histological type, multifocality, lymphovascular invasion, percentage of ER positive cells and the number of positive SLNs. We additionally included a customized variable, the number of SLN metastases multiplied by tumor size. This variable could represent the possible non-linear interactions of tumor size and tumor burden in SLNs. The moderate patient cohort size enabled us to apply accurate preoperative clinical information such as palpability that might be missing in larger studies. The model presented in this study can be processed further into a computational calculator to serve clinicians’ needs.
Diagnosis and Treatment of 75 Patients with Idiopathic Lobular Granulomatous Mastitis
Published in Journal of Investigative Surgery, 2019
Jieqing Li
Breast mass was the most common symptom, occurring in 89.3% (67/75) patients. Other symptoms included skin swelling (2.7%, 2/75), breast pain (2.7%, 2/75) and nipple discharge (5.3%, 4/75). Before they visited doctors, 32% (24/75) of patients experienced a rapid increase in breast mass, 12% (9/75) experienced skin ulceration, 2.7% (2/75) had nipple bleeding and 6.7% (5/75) had nipple discharge within 9 to 60 days (median 30 days). Moreover, 41.3% (31/75) received antibiotics before admission, in which 25.8% (8/31) patients had reduction in lumps and skin redness, but antibiotics treatment was ineffective in 74.2% (23/31) of patients (Table 2). Physical examination showed unilateral mass in 73 patients (left, 62.7%, 47/75; right, 34.7%, 26/75) and bilateral mass in two patients. Furthermore, 92% (69/75) had single lesion, 5.3% (4/75) two lesions and 2 cases had three lesions. Lesions were located in the areola area in 15 patients. The proportion of the mass in the peripheral area of the breast was higher than that in the areola area. The mass size by palpation was 1.5 cm × 1.0 cm ∼9.0 cm × 8.0 cm, with a mean size of (3.90 ± 2.05) cm × (4.83 ± 2.44) cm. Among these patients, 10 patients (13.3%) showed palpable axillary lymph nodes. Twenty-one cases (28%) had ipsilateral nipple retraction, 3 cases (4%) had pelvic surface skin edema, 3 cases (4%) had sinus formation, 1 case (1.3%) had the dimple sign and 18 cases (24%) had acute inflammation (Table 3).
Related Knowledge Centers
- Cancer Staging
- Lymph Node
- Lymphatic Vessel
- Metastasis
- Abdomen
- Pectoralis Major
- Breast Cancer
- Axilla
- Pectoral Axillary Lymph Nodes
- Pectoralis Minor