Contralateral Axillary Lymph Node Metastasis in a Patient with Relapsed Breast Cancer: Locoregional Event or Distant Metastasis Disease?

Abstract

<b><i>Introduction:</i></b> Contralateral axillary lymph node metastasis (CAM) is a rare clinical condition in patients with breast cancer. It can be explained from hematogenous spread from the original primary tumor (stage IV) to aberrant regional lymphatic drainage to the contralateral axilla. However, according to the current clinical guidelines, regardless of its origin, CAM is considered as metastatic disease. <b><i>Case Presentation:</i></b> A 68-year-old woman presented with relapsed right breast cancer; lymphoscintigraphy showed only one sentinel lymph node (SLN) in the contralateral axilla (left region). Twenty-four hours later, the patient underwent upper internal quadrantectomy and bilateral selective lymph node biopsy. The final pathological analysis revealed one contralateral macrometastasis (>4 mm) in one left SLN. Subsequently, second-level left lymphadenectomy was performed. Currently the patient is being treated with chemotherapy, with appropriate clinical response. <b><i>Discussion:</i></b> Our patient was considered to be node-positive rather than having metastatic disease since the preoperative lymphoscintigraphy demonstrated contralateral lymphatic drainage. Through preoperative scan in patients with relapsed breast cancer with clinically negative lymph nodes and CAM, it is possible to identify those cases that would benefit from therapy with curative intention.

COVID-19 Vaccine-Related Axillary and Cervical Lymphadenopathy in Patients with Current or Prior Breast Cancer and Other Malignancies: Cross-Sectional Imaging Findings on MRI, CT, and PET-CT

“…Even though adenopathy in Patient 4 was contralateral to the patient’s original breast malignancy, biopsy was pursued due to palpable nature of adenopathy and history of stage IIIC breast cancer. Contralateral nodal breast cancer metastases have rarely been reported [ 9 10 ], and therefore if patients have history of more aggressive, higher stage, or locally advanced breast cancer, a lower threshold to biopsy an indeterminate node may be appropriate, even if contralateral to the original malignancy. In contrast, Patients 2 and 3 were considered low risk for nodal metastasis due to negative axillary lymph node status on the side ipsilateral to primary malignancy; the contralateral lymph nodes could therefore be safely assumed benign without biopsy.…”