188宝金博页面版

Case ReportCutaneous Erythema at Scar Site of ModifiedRadical Mastectomy: An Unexpected Manifestation ofRecurrent CarcinomaAwrad Mohammed-Reda Nasralla, 1 Mohammed Abdulirazzaq Al-Duhileb, 1Ali Jamal-Aldein Arini, 1 and Samir Sami Amr 21 Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia2 Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi ArabiaCorrespondence should be addressed to Awrad Mohammed-Reda Nasralla; a.nasserallah@hotmail.comReceived 11 April 2017; Revised 29 June 2017; Accepted 11 July 2017; Published 10 August 2017Academic Editor: Oded OlshaCopyright © 2017 Awrad Mohammed-Reda Nasralla et al. T h is is an open access article distributed under the Creative CommonsAttribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work isproperly cited.A 44-year-old woman presented with marked erythema over right mastectomy scar, while on Herceptin therapy. She hadneoadjuvant chemotherapy, modif i ed radical mastectomy, and radiotherapy less than one year earlier for the treatment of invasiveductal carcinoma. On physical examination, no palpable masses were detected in the erythematous skin. A biopsy revealedpermeation of the skin lymphatics by emboli of metastatic ductal carcinoma, similar to what is seen in inf l ammatory carcinoma.T h e involved skin was excised, followed by immediate reconstruction with transverse rectus abdominis muscle (TRAM) f l ap. Onfollow-up, the wound was healing well, with no signs of inf l ammation.1. IntroductionFive to ten percent of patients with operable breast cancerdevelop a chest wall recurrence within 10 years followingmastectomy [1, 2]. Local skin recurrence is uncommon andis believed to manifest as hard nodule, but it is rare to presentas rash or erythema [3, 4]. We present herein a patientwith skin rash within less than a year following neoadjuvantchemotherapy,mastectomy,andadjuvantradiotherapy,whileshe was still receiving adjuvant biological therapy.2. Case ReportA 44-year-old woman had invasive ductal carcinoma of theright breast. On initial presentation, she had a palpable 7 ×5cm well-circumscribed hard mass at upper outer quadrantof the right breast with no skin changes nor tetheringor attachment to the underlying muscle. T h ere were noother ipsilateral or contralateral palpable masses. T h e rightaxilla had a palpable 1cm lymph node. Core biopsy ofthe breast mass revealed invasive ductal carcinoma, ER/PRnegative, and HER-2 positive. T h e US-guided FNAC of theright axillary lymph node conf i rmed the presence metastaticbreast cancer. She received neoadjuvant chemotherapy andbiological therapy; then, she underwent modif i ed radicalmastectomy followed by radiotherapy. Pathological exami-nation of the mastectomy specimen revealed a 3cm tumornodule that showed on histological examination invasiveductal carcinoma, with ductal carcinoma in situ, comedotype, grade 3, ER/PR negative, and Her2-neu positive. T h etumorhadclearsurgicalmargins,and9axillarylymphnodeswere all negative for malignancy.Six months following the surgery, she presented withredness over the mastectomy scar that increased in sizerapidly within 2 months. On physical examination, the skinlesion was a localized, well-def i ned, indurated erythematousnot warm plaque measuring 5 × 4cm overlying the rightanterior chest wall over the mastectomy scar (Figure 1).Initially, it was thought that the skin change was relatedto the radiotherapy, but the skin lesion increased in size andthe patient was referred to Dermatology Clinic for consul-tation. She was given topical corticosteroid and antifungalHindawiCase Reports in SurgeryVolume 2017, Article ID 6879626, 3 pageshttps://doi.org/10.1155/2017/6879626