From Furuncle to Axillary Web Syndrome: Shedding Light on Histopathology and Pathogenesis

Abstract

Axillary web syndrome (AWS) is defined as a cord-like structure extending from the axilla to the medial arm following axillary surgery in women with breast cancer. There is only limited literature on the pathogenesis of this syndrome and the etiology of the cord. A 57-year-old man presented with a band-like skin depression and tightness over the medial aspect of his arm extending from the axilla to the antecubital fossa following development of a furuncle in the ipsilateral axilla. Histopathologic examination of the ‘band’ revealed fibroblastic proliferation surrounding the lymphatic vessel which was identified by presence of an obvious valve as well as positive staining for D2-40, a specific marker for lymphatic endothelium. This is the first report of AWS following axillary furunculosis. This case adds to the limited data on the histopathology of AWS, further confirming the etiology of the ‘cord’ to be of lymphatic origin.

Axillary web syndrome following secondary breast-conserving surgery: a case report

“…The hypothesis is consistent with the B-type ultrasonography findings, but was not definitive due to the lack of a histopathology report. Most of the investigators were inclined to define the cord-like structure as a lymph vessel [7,8,10,11]. …”

Cording following treatment for breast cancer

“…The condition may be related to abnormalities in either the axillary vasculature or the lymphatics[2,3,9]. Anatomic studies of resected cords reveal that these structures may represent dilated and thrombosed lymphatics and/or thrombosed superficial veins[3,9]. The condition is considered to be a variation of Mondor’s disease, a rare thrombophlebitis of the subcutaneous veins caused by trauma such as surgery[10].…”

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“…Several studies of dissected cords have shown thrombosed and dilated lymphatics and superficial veins. For this reason AWS may be considered a variant of Mondor's disease, which is a superficial thrombophlebitis presenting with a palpable cord on the breast [2,11,12].…”