case_images: PMC10837370_01
case_images: Radiological findings at the initial examination.. (a, b) An 18F-fluorodeoxyglucose-position emission tomography (FDG-PET) image in the delayed phase/computed tomography, a fusion image acquired in the axial plane, and an FDG-PET image in the delayed phase acquired in the axial plane show 18F-fluorodeoxyglucose (FDG) accumulation (standardized uptake value max of 5.3 in the early phase and 6.6 in the delayed phase) at a cervical lymph node (arrow). (c, d) An FDG-PET image in the delayed phase/computed tomography, a fusion image acquired in the axial plane, and an FDG-PET image in the delayed phase acquired in the axial plane show FDG accumulation (standardized uptake value max of 4.1 in the early phase and 4.2 in the delayed phase) at a cervical lymph node (arrowhead).
case_images: cureus-0016-00000051617-i01.jpg
case_images: PMC10837370_01_cureus-0016-00000051617-i01.jpg
case_images: FIG1
case_images: Further, 18F-fluorodeoxyglucose positron emission tomography showed 18F-fluorodeoxyglucose accumulation at two cervical lymph nodes (short axis, 7 mm and 5 mm) at level II (defined by Robbins et al.) on the left side, indicating distant metastases (Figures 1a-1d).
case_images: Radiological findings about four months after the start of chemotherapy.. (a, b) An 18F-fluorodeoxyglucose-position emission tomography (FDG-PET) image in the delayed phase/computed tomography, a fusion image acquired in the axial plane, and an FDG-PET image in the delayed phase acquired in the axial plane show reductions in size and FDG accumulation (standardized uptake value max of 3.8 in the early phase, and 5.2 in the delayed phase) compared with the initial examination at a cervical lymph node (arrow). (c, d) An FDG-PET image in the delayed phase/computed tomography, a fusion image acquired in the axial plane, and an FDG-PET image in the delayed phase acquired in the axial plane show reductions in the size of a lymph node with almost complete disappearance of FDG accumulation (arrowhead).
case_images: cureus-0016-00000051617-i02.jpg
case_images: PMC10837370_01_cureus-0016-00000051617-i02.jpg
case_images: FIG2
case_images: After chemotherapy, the short axes of the two lymph nodes at level II on the left side decreased to 4 mm and 2 mm, leading to judge that chemotherapy for the cervical lymph node metastases was effective (Figures 2a-2d).
case_images: Dose distribution of postmastectomy radiation therapy.. The green line indicates the 95% isodose line. (a) Dose distribution on an axial image. (b) Dose distribution on a coronal image. (c) Dose distribution on a sagittal image.
case_images: cureus-0016-00000051617-i03.jpg
case_images: PMC10837370_01_cureus-0016-00000051617-i03.jpg
case_images: FIG3
case_images: First, postmastectomy radiation therapy (50 Gy in 25 fractions) was administered to the left chest wall, the left supraclavicular lymph node region, and the left infraclavicular lymph node region (Figures 3a-3c).
case_images: Dose distributions in radiation therapy to the cervical lymph node metastases and to ipsilateral Robbins levels II to III region.. The green line indicates a 95% isodose line. (a) Dose distribution on an axial image. (b) Dose distribution on a coronal image. (c) Dose distribution on a sagittal image.
case_images: cureus-0016-00000051617-i04.jpg
case_images: PMC10837370_01_cureus-0016-00000051617-i04.jpg
case_images: FIG4
case_images: Then, radical radiation therapy, using a radiation dose for head and neck cancers, was administered to the cervical lymph node metastases (Figures 4a-4c).
case_images: PMC10837370_02
case_images: Radiological findings about two years and two months after the start of radiation therapy.. (a, b) The axial computed tomography images. The cervical lymph node metastases had shrunk and were no longer identifiable.
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case_images: PMC10837370_02_cureus-0016-00000051617-i05.jpg
case_images: FIG5
case_images: As of this writing, recurrence-free status has been maintained for two years and four months after the completion of radiation therapy, and we are still following up on this patient (Figures 5a, 5b).