Name : Maryam
Affiliation : Teb Azma Imaging Center,Ghom,Iran
Academic Degree: Radiologist
Resident : ----------------
Gender : Female
Age : 45
A 45-year-old woman, known case of left breast invasive ductal carcinoma & mastectomy, presents with contralateral breast & upper limb swelling 10 days after starting radiotherapy.
The patient firstly underwent mammography which revealed generalized increased density, skin & trabecular thickening. Then ultrasound is performed; moreover skin & trabecular thickening, at least two lymph nodes are noted at axillary region (lateral to pectoralis minor muscle: level I) with abnormal focal areas of cortical thickening & suspicious feature (BIRADS IV). U/S guided core needle biopsy is performed.
mastitis, CHF, inflamatory breast carcinoma
Metastatic lymph node by invasive ductal carcinoma.
Discussion (Related Text)
The morphologic assessment of lymph nodes appropriately focuses most of the attention on the cortex of the lymph node. Foreign bodies tend to accumulate in the medullary sinuses of the lymph node, affecting the mediastinum first, and then affecting the cortex only late in the process. Metastases, on the other hand, affect the subcapsular sinuses and cortical sinuses first, affecting the lymph node from the cortex inwardly The mediastinum is displaced and compressed inward by the thickening cortex. The out margins of the node can also be affected. Tumor deposits in the subcapsular sinuses tend to create focal outward bulges or lobulations in the outer contour of the lymph node. Tumor deposits in the more deeply located cortical sinusoids tend to create convex inward indentations into the mediastinum. Both processes lead to eccentric widening of the cortex early and to diffuse widening later on. Subcapsular deposits can invade through the capsule of the lymph node and can stimulate neovascularity that enters the node through abnormal routes. Thus, cortical changes are key to diagnosing lymph node metastases. Sonography can be helpful in assessing the axilla in previously treated breast cancer patients who develop arm swelling. If the patient has undergone full axillary dissection, the swelling could be lymphedema related to removal of lymph tissue, and there may be no findings. Such patients might also have chronic seromas, hematomas, lymphoceles, or fat necrosis in the axilla, but they might also have recurrent carcinoma in previously undetected and unresected lymph nodes. There might also be invasive tumor within the soft tissues of the axilla if there was perinodal invasion before lymphadenectomy. Ultrasound guided biopsy can be performed to document the suspected recurrence.
Breast Imaging, Daniel B. Kopans et al. Breast Ultrasound. A. Thomas Stavros.