case_images: PMC11324225_01
case_images: Local findings. a A 17 cm-sized exposed tumor covered with pus, necrotic tissue, and mucus occupied the whole right breast before chemotherapy. b Marked tumor shrinkage and large skin defect were observed after chemotherapy. c Skin defect was well covered with the LDMC flap.
case_images: cro-2024-0017-0001-539717_F01.jpg
case_images: PMC11324225_01_cro-2024-0017-0001-539717_F01.jpg
case_images: F1
case_images: Inspection showed a huge and exposed breast tumor on her right chest wall (Fig. 1a). To get favorable local control, the patient thereafter received sequential chemotherapy, i.e., anthracycline-containing chemotherapy followed by bevacizumab plus paclitaxel therapy, resulting in marked tumor shrinkage (Fig. 1b, 2d). Due to the strong patient's preference for long-lasting local control after the tumor regression with the sequential chemotherapy, the patient further underwent mastectomy and regional lymph node dissection including removal of the still enlarged parasternal lymph nodes followed by covering of the large skin defect with a LDMC flap using a spindle skin island, 15 x 8 cm in size (Fig. 1c).
case_images: Computed tomography (CT) findings. Before chemotherapy. A large tumor (arrow) was observed on the right chest wall (a). Enlarged lymph nodes were observed in the axilla (b: arrows) and parasternum (c: arrow). After chemotherapy, marked tumor shrinkage was observed (d: arrow). Enlarged lymph nodes in the axilla (e: arrows) and parasternum (f: arrow) showed no change in size.
case_images: cro-2024-0017-0001-539717_F02.jpg
case_images: PMC11324225_01_cro-2024-0017-0001-539717_F02.jpg
case_images: F2
case_images: Computed tomography (CT) showed an oval solid tumor (Fig. 2a), lymph node swelling both in the axilla and parasternum (Fig. 2b, c), and no distant metastases. To get favorable local control, the patient thereafter received sequential chemotherapy, i.e., anthracycline-containing chemotherapy followed by bevacizumab plus paclitaxel therapy, resulting in marked tumor shrinkage (Fig. 1b, 2d). Axillar and parasternal lymph nodes, however, remained unchanged in size (Fig. 2e, f).
case_images: Pathologic findings. a Macroscopic view showed a gelatinous tumor with distinct margins (arrows). b Low magnified view of the main tumor showed abundant mucus and very sparse cancer cell remnants (arrows). c Magnified view showed cancer cell clusters in the massive mucus. d Cut surface of the parasternal lymph node contained massive gel-like material (arrow). e On low magnified images of the parasternal lymph node, a large amount of mucus could be seen, but the presence of cancer cells was not clear. f Magnified view of the lymph node showed scant cancer cell remnants (arrows).
case_images: cro-2024-0017-0001-539717_F03.jpg
case_images: PMC11324225_01_cro-2024-0017-0001-539717_F03.jpg
case_images: F3
case_images: Postoperative pathological study showed sparse cancer cell remnants with abundant mucus in both the primary tumor and the dissected lymph nodes (Fig. 3a-f).