Upper limb soft tissue metastasis in post mastectomy patient

Reddy, Janani S.; Mahipathy, Surya Rao Rao Venkata; Durairaj, Alagar Raja; Sundaramurthy, Narayanamurthy

doi:10.18203/2349-2902.isj20184105

Cited by 1 publication

(1 citation statement)

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“…29 phenomenon in the literature. 30 A large academic cancer center recently reviewed their soft-tissue metastases from carcinomas and found that there were 13 cases of breast cancer with distal soft-tissue metastases. Among these were 3 to the shoulder, 2 to the chest wall, 2 to the arm, 1 to the back, 1 to the scapula, and 1 to the abdominal wall.…”

Section: Discussionmentioning

confidence: 99%

The spectrum of brachial plexopathy from perineural spread of breast cancer

Jack

Smith

Capek

et al. 2022

Journal of Neurosurgery

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OBJECTIVE Perineural spread of breast cancer to the brachial plexus can lead to pain, sensory alterations, and upper-extremity weakness. Although rare, perineural spread is an often-misdiagnosed long-term complication following breast cancer diagnosis. The objective of this study was to critically review the clinical, radiological, and pathological findings of biopsy-proven perineural spread of breast cancer to the brachial plexus. METHODS This is a retrospective study from a single institution in which a total of 19 patients with brachial plexus involvement from perineural spread of breast cancer who underwent fascicular biopsy between 1999 and 2021 were identified. Clinical, radiographic, and pathological data were retrospectively collected. Descriptive statistics were calculated for the cohort. RESULTS The mean age of patients at the time of diagnosis of breast cancer perineural spread was 60.6 ± 11.5 years. The diagnosis of brachial plexopathy due to perineural spread was on average 12 years after the primary diagnosis of breast cancer. There was also a delay in diagnosis due to the rarity of this disease, with a mean time from initial symptom onset to diagnosis of perineural spread of 25 ± 30 months. All patients at the time of presentation had upper-extremity weakness and pain. Nearly all patients demonstrated T2 signal change and nodular so-called sugar-coating contrast enhancement on brachial plexus MRI. Similarly, all patients who underwent PET/MRI or PET/CT had increased FDG uptake in the involved brachial plexus. Breast cancer perineural spread has an overall poor prognosis, with 16 of 19 patients dying within 5.9 ± 3.0 years after diagnosis of perineural spread. CONCLUSIONS Perineural spread should be considered in patients with a history of breast cancer, even 10 years after primary diagnosis, especially in patients who present with arm pain, weakness, and/or sensory changes. Further diagnostic workup with electrodiagnostic studies; brachial plexus MRI, PET/CT, or PET/MRI; and possibly nerve biopsy is warranted to ensure accurate diagnosis.

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Section: Discussionmentioning

confidence: 99%