Subclavian brachial plexus metastasis from breast cancer:A case report

BACKGROUND The common area of breast cancer metastases are bone,lung and liver.Brachial plexus metastasis from breast cancer is extremely rare.We report a case of subclavian brachial plexus metastasis from breast cancer 6 years postoperative,which were detected by ultrasound,magnetic resonance imaging(MRI)and 18Ffluorodeoxyglucose positron emission tomography and computed tomography(FDG-PET/CT).CASE SUMMARY Our study reports a 64-year-old woman who had right breast cancer and underwent radical mastectomy 6 years before.Ultrasound first revealed a soft lesion measuring 38 mm×37 mm which located on the right side of the clavicle to the armpit subcutaneously.The right subclavian brachial plexus(beam level)was significantly thickened,wrapped around by a hypoechoic lesion,the surrounded axillary artery and vein were pressed.MRI brachial plexus scan showed that the right side of brachial plexus was enlarged compared with the left side and brachial plexus bundle in the distance showed a flake shadow.FDG-PET/CT revealed that the right side of brachial plexus nodular appearance with increased FDG metabolism.These results supported brachial plexus metastasis from breast cancer.Ultrasound exam also found many lesions between pectoralis major,deltoid muscle and inner upper arm.The lesion puncture was performed under ultrasound guidance and the tissue was sent for pathology.Pathology showed large areas of tumor cells in fibroblast tissue.Immunohistochemistry showed the following results:A2-1:GATA3(+),ER(+,strong,90%),PR(+,moderate,10%),HER-2(3+),Ki67(+15%),P120(membrane+),P63(-),E-cadherin(+),CK5/6(-).These results were consistent with the primary right breast cancer characteristics,thus supporting lesion metastasis from breast cancer.CONCLUSION The brachial plexus metastasis from breast cancer is uncommon.Ultrasound has great value in detecting brachial plexus metastasis of breast cancer.It is an easy,non-invasive and affordable method.Close attention should be paid to new grown out lesions in those patients who had a history of breast cancer when doing ultrasound review.

Ultrasound-guided needle release plus corticosteroid injection of superficial radial nerve:A case report

BACKGROUND The radial nerve(RN)splits into two main branches at the elbow:The superficial branch of RN(SBRN)and the deep branch of RN.The SBRN can be easily damaged in acute trauma due to its superficial feature.CASE SUMMARY A 55-year-old male patient injured his right wrist 10 mo ago.Debridement,suturing and bandaging were performed in the emergency room.Six months after the scar had healed,he felt numbness and tingling in the dorsal surface of the thumb of the right hand.So the surgery of resection and SBRN anastomosis were performed.The pathological findings showed it as traumatic neuroma.Four months after surgery,the patient felt numbness and tingling in the right dorsal surface of the thumb again.The tenderness was marked in the operated area.Ultrasound indicated that the SBRN was adhered to the surrounding tissue.The patient refused further surgical treatment and underwent ultrasound-guided needle release plus corticosteroid injection of the SBRN.Four weeks later,the tenderness in the surgical area was reduced by 70%,the numbness in the dorsal surface of the thumb of the right hand was reduced by 40%and the nerve swelling evaluated by ultrasound was reduced.Four months passed,he did not feel any numbness or tingling sensation of his right wrist.This is the first report of ultrasound-guided needle release plus corticosteroid injection of the SBRN.CONCLUSION Ultrasound can evaluate the condition of the RN,and the relationship with surrounding tissues.Ultrasound-guided needle release plus corticosteroid injection is an effective and safe treatment for SBRN adhesion.