Orli Friedman-Eldar
Hebrew University Jerusalem Israel, IsraelTitle: Axillary Reverse Lymphatic Mapping in the Treatment of Axillary Accessory Breast Cancer: A Case Report and Review of Management
Abstract
Introduction: Accessory breast tissue is a rare aberration of normal breast development, that presents most
commonly in the axilla. Similar to normal breast tissue, it can undergo physiologic and pathologic changes,
including malignant transformation. We report a rare case of accessory breast cancer, treated with surgical
resection and axillary reverse mapping (ARM), and review current literature focusing on management.
Case Report: A 68-year-old female with a history of left breast cancer treated with lumpectomy and axillary
dissection, who later developed in-breast recurrence treated with re-lumpectomy and sentinel node biopsy
which mapped at the contralateral (right) axilla, but was negative. Two years later screening imaging revealed
right axillary tail focal asymmetry with two spiculated masses. Core biopsy showed invasive ductal carcinoma
(IDC), and histologic examination of the biopsy could not determine whether this represents a new primary
breast cancer or axillary metastasis from the contralateral site. She underwent lumpectomy of the two masses
and sentinel node biopsy. During surgery, the masses were identified in the axilla itself, rather than the
axillary tail. Final pathology revealed IDC, pT1N0(sn), and extensive ductal carcinoma in situ (DCIS). Due to
positive margins, she underwent re-lumpectomy with ARM. Final pathology revealed residual DCIS with
negative new margins. The patient was referred for adjuvant radiotherapy.
Conclusions: Accessory axillary breast tissue can be confused with axillary tail tissue. It is necessary for the
surgeon to distinguish between them by meticulous physical examination and radiologic evaluation, as
resection of axillary breast tissue may warrant reverse lymphatic mapping for lymphedema prevention.
Biography
Orli Friedman-Eldar is a certified Breast Surgical Oncologist in Israel. After she completed general surgery
residency she trained for 2 years in Jackson Memorial Hospital, Miami, USA, as part of the SSO-accredited
fellowship program in breast surgical oncology.
She is currently working as an attending breast surgeon at ‘Kaplan Medical Center’, Rehovot, Israel, and is
actively involved in research, both basic and clinical. Orli also serves as a reviewer for several medical
journals
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