A 57-year-old female patient, with no relevant medical history, ex-smoker for 15 years, was referred from the Early Detection Unit of Breast Cancer for a 3.5-cm lymph node in the axillary quadrant.
Diagnosis is made by biopsy, MRI and axillary ultrasound of ductal carcinoma of the left breast with axillary involvement.
Neoadjuvant treatment was established with standard chemotherapy regimen with ECF 75 (4 cycles) followed by docetaxel (4 cycles).
After treatment there is an absence of radiological response and proceeds after surgery, performing a left mastectomy and lymphadenectomy levels I and II Berg.
The definitive pathological diagnosis is grade III ductal carcinoma, 2.6 cm, Her2-neu negative.
Receptors, estrogen 98%.
Progesterone 38%.
P53 29%.
Ki 67 35%.
Her-2 0%.
Keratin 56 positive 1/3.
EGFR negative.
Positive E-Caderin 3/3.
Androgen negative.
BCL2 positive 2/3.
It is a luminal B-Ki67 pattern with metastases in 1/19 lymph nodes.
In the immediate postoperative period she presented mild bleeding exteriorized by the drainage, being carried out conservative treatment.
On the seventh postoperative day, a 400 ml flow was observed through the axillary drainage, with the appearance of stenosis, suggestive of lymphorrhea.
Chylous fluid was confirmed by biochemical study (Triglycerides: 800 mg/dl, total cholesterol: 47 mg/dl).
A diet with restriction of fat is indicated, recommending the ingestion of foods with medium chain triglycerides and simultaneous subcutaneous somatostatin every 8 hours for 10 days.
With these measures, the quantity and aspect of axillary drainage improved and normalized, allowing its removal 20 days after surgery.
In subsequent controls, no other complications were observed, and the patient started to complete oncological treatment.
The patient is asymptomatic and disease free after 37 months of follow-up.
