A 65 years old female underwent right radical mastectomy 10 years back. Patient now presents with multiple subcutaneous nodules in right upper limb. What is the most probable diagnosis?
Correct Answer: Lymphangiosarcoma
Description: Ans. is 'a' i.e., Lymphangiosarcoma * Multiple subcutaneous swellings which arise in upper limb of a patient operated for radical mastectomy are most likely to be lympangiosarcoma. They should be distinguished from metastases.Phenomena resulting from lymphatic obstruction in advanced breast cancerPeau d'orange* Peau d'orange is caused by cutaneous lymphatic oedema. Where the infiltrated skin is tethered by the sweat ducts it cannot swell, leading to an appearance like orange skin.Cancer-en-cuirasse* The skin of the chest is infiltrated with carcinoma and has been likened to a coat. It may be associated with a grossly swollen arm. This usually occurs in cases with local recurrence after mastectomy and is occasionally seen to follow the distribution of irradiation to the chest wall. The condition may respond to palliative systemic treatment but prognosis in terms of survival is poor.Lymphangiosarcoma* Lymphangiosarcoma is a rare complication of lymphoedema with an onset many years after the original treatment. It takes the form of multiple subcutaneous nodules in the upper limb and must be distinguished from recurrent carcinoma of the breast. The prognosis is poor but some cases respond to cytotoxic therapy or irradiation. Interscapulothoracic (forequarter) amputation is rarely indicated.
Category:
Surgery
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