Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2022; 10(33): 12261-12267
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12261
Subclavian brachial plexus metastasis from breast cancer: A case report
Zeng Zeng, Nan Lin, Li-Tao Sun, Cong-Xian Chen
Zeng Zeng, Li-Tao Sun, Cong-Xian Chen, Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Nan Lin, Plastic Surgery Center, Department of Hand & Reconstruct Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Author contributions: Zeng Z, Lin N, Sun LT and Chen CX were responsible for substantial contributions to conception and design; Chen CX and Lin N was responsible for the acquisition of data; Zeng Z was responsible for drafting the article; Zeng Z, Lin N, Sun LT and Chen CX were responsible for the final approval of the version to be published.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cong-Xian Chen, Doctor,Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou 310000, Zhejiang Province, China. kema320@qq.com
Received: June 4, 2022
Peer-review started: June 4, 2022
First decision: August 4, 2022
Revised: August 6, 2022
Accepted: October 26, 2022
Article in press: October 26, 2022
Published online: November 26, 2022
Abstract
BACKGROUND

The common area of breast cancer metastases are bone, lung and liver. Brachial plexus metastasis from breast cancer is extremely rare. We report a case of subclavian brachial plexus metastasis from breast cancer 6 years postoperative, which were detected by ultrasound, magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT).

CASE SUMMARY

Our study reports a 64-year-old woman who had right breast cancer and underwent radical mastectomy 6 years before. Ultrasound first revealed a soft lesion measuring 38 mm × 37 mm which located on the right side of the clavicle to the armpit subcutaneously. The right subclavian brachial plexus (beam level) was significantly thickened, wrapped around by a hypoechoic lesion, the surrounded axillary artery and vein were pressed. MRI brachial plexus scan showed that the right side of brachial plexus was enlarged compared with the left side and brachial plexus bundle in the distance showed a flake shadow. FDG-PET/CT revealed that the right side of brachial plexus nodular appearance with increased FDG metabolism. These results supported brachial plexus metastasis from breast cancer. Ultrasound exam also found many lesions between pectoralis major, deltoid muscle and inner upper arm. The lesion puncture was performed under ultrasound guidance and the tissue was sent for pathology. Pathology showed large areas of tumor cells in fibroblast tissue. Immunohistochemistry showed the following results: A2-1: GATA3 (+), ER (+, strong, 90%), PR (+, moderate, 10%), HER-2 (3+), Ki67 (+15%), P120 (membrane+), P63 (-), E-cadherin (+), CK5/6 (-). These results were consistent with the primary right breast cancer characteristics, thus supporting lesion metastasis from breast cancer.

CONCLUSION

The brachial plexus metastasis from breast cancer is uncommon. Ultrasound has great value in detecting brachial plexus metastasis of breast cancer. It is an easy, non-invasive and affordable method. Close attention should be paid to new grown out lesions in those patients who had a history of breast cancer when doing ultrasound review.

Keywords: Brachial plexus, Metastasis, Breast Cancer, Ultrasound, Magnetic resonance imaging, 18F-fluorodeoxyglucose positron emission tomography/computed tomography, Case report

Core Tip: Breast cancer metastases are commonly found in bone, lung and liver. Brachial plexus metastasis from breast cancer is extremely rare. We here report a 64-year-old woman who had brachial plexus metastasis from breast cancer. Ultrasound is an easy, non-invasive and affordable method for the detection of brachial plexus metastasis from breast cancer. Attention should be paid to new lesions in patients with a history of breast cancer when performing ultrasound review.