Focal radiotracer uptake in the falciform ligament; A rare lymphoscintigraphic pattern in breast cancer

Document Type : Case report

Authors

Nuclear Medicine Research Center, Mashhad university of Medical Sciences, Mashhad, Iran

Abstract

Breast cancer lymphoscintigraphy is a crucial tool in pre-operative assessment, typically revealing sentinel lymph node drainage patterns within axillary and extra-axillary regions. However, rare cases challenge conventional understanding. We report a 67-year-old woman with breast cancer, where lymphoscintigraphy revealed focal uptake within the falciform ligament of the liver, an exceedingly rare phenomenon. Clinical examination and imaging showed no axillary lymph node involvement. Lymphoscintigraphy and subsequent Single-photon emission computed tomography (SPECT)/computed tomography (CT) uncovered two axillary lymph nodes and an atypical focal uptake in the falciform ligament. Histopathology revealed no metastasis in sentinel nodes. The conventional understanding of breast lymphatic drainage primarily involves axillary and extra-axillary pathways, with the falciform ligament rarely implicated. This case suggests a unique lymphatic pathway connecting the breast and liver, possibly influencing metastasis. Factors such as lymphatic obstruction and valvular incompetency may contribute. This case highlights the importance of comprehensive lymphatic mapping in breast cancer evaluation and underscores the need for further research into atypical lymphatic pathways.

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  1. Estourgie SH, Nieweg OE, Olmos RA, Emiel J, Kroon BB. Lymphatic drainage patterns from the breast. Annals of surgery. 2004; 239(2):232-7.
  2. Sumadewi KT. Embryology, anatomy and physiology of the liver. Indian Journal of Clinical Anatomy and Physiology. 2023; 10(3):138-44.
  3. Nappi O, Ferrara G, Lanniello G, Wick MR. Metastatic hepatocellular carcinoma of the breast, simulating gynecomastia: diagnosis by fine‐needle aspiration biopsy. Diagnostic cytopathology. 1992; 8(6):588-92.
  4. Ohtani O, Ohtani Y. Lymph circulation in the liver. Anatomical Record. 2008; 291(6): 643-52.
  5. Lupinacci RM, Paye F, Coelho FF, Kruger JA, Herman P. Lymphatic drainage of the liver and its implications in the management of colorectal cancer liver metastases. Updates in surgery. 2014; 66:239-45.
  6. Iii JHO, Peterson MS, Ferris J V, Carr BS, Baron RL. Sanjeev Katyal, MD Abbreviation: HCC hepatocellular carcinoma 1 From the Departments of Radiology Extrahepatic Metastases of Hepatocellular Carcinoma 1. Vol. 216, Radiology. 2000.
  7. Vermeeren L, Tanis PJ, Nieweg OE, Olmos Lymphoscintigraphy of a breast tumor showing focal tracer accumulation along the falciform ligament of the liver. Clinical nuclear medicine. 2010; 35(3):168-9.
  8. Tokisawa H, Aruga T, Kumaki Y, Iwamoto N, Yonekura R, Ishiba T, Honda Y, Suzuki M. Metastasis of breast cancer to liver through direct lymphatic drainage: a case report. J Int Med Res. 2021; 49(12): 3000605211064793.