c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Resection of Solitary Scalene Nodal Breast Cancer Metastasis: 4

A D V E R T I S E M E N T

   
 

This sagittal cut shows the lesion posterior to the clavicle and lying on the anterior scalene. The brachial plexus nerves are not involved. Note the radiation fibrosis at the apex of the lung from the 1996 supraclavicular radiotherapy.       

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Resection of Solitary Scalene Nodal Breast Cancer Metastasis: 5

A D V E R T I S E M E N T

   
 

The location of the lesion is shown schematically. The patient was presented in combined conference with representatives of surgery, medical oncology, radiation oncology and pathology. Due to the lack of control with chemotherapy and the prior maximal supraclavicular radiation (danger of brachial plexus injury with additional radiation), the consensus was to offer the patient the option of surgical resection (see modified neck dissection) with the goal of local control, and to prevent the morbidity associated with vascular and neurological invasion with further growth. The probability of resection for cure with clean margins was low, and was presented to the patient as such. It was anticipated that it might be necessary to remove the medial part of the clavicle for safe exposure, and to possibly resect internal jugular and reconstruct the subclavian vein. The morbidity of the procedure was weighed against the inherent future morbidity of the unresponsive lesion. The patient elected to go ahead with the surgery.   

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Resection of Solitary Scalene Nodal Breast Cancer Metastasis: 6

A D V E R T I S E M E N T

   
 

The neck and groin (in the event a vein graft was needed) were prepped and the patient was placed in semi-Fowlers position (torso at 45 degrees with knees elevated). The incision along the lower part of the sternocleidomastoid, curving posteriorly above the clavicle is marked with the solid line. The circle indicates the location of the lesion, and the dashed line is the external jugular vein.      

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This page was last modified on 10/29/2001.