Do hematologic malignancies cause a barrier for sentinel lymph node mapping in endometrial cancer? A case report

Sentinel lymph node (SLN) mapping has changed the way of lymph node assessment and provided a minimal invasive option that lessens the negative effects of a full lymphadenectomy, has become a crucial tool in the treatment of endometrial cancer. Chronic lymphocytic leukemia (CLL) and endometrial cancer diagnosis at the same is a rare condition. This case report presents a 66-year-old woman admitting to the hospital with the complaint of postmenopausal bleeding. After hysteroscopic evaluation and Magnetic Resonance imaging confirming the endometrial cancer, total laparoscopic hysterectomy and bilateral salphingo-ooferectomy with SLN mapping operation was planned. In the preoperative preparation she was also diagnosed with CLL. Considering the possible lymphatic obstruction, the risk of SLN mapping failure was foreseen, yet still the operation was performed as planned. This report will highlight a case where endometrial cancer and CLL were identified simultaneously, along with successful SLN mapping.

Follicular lymphoma without lymphadenopathy incidentally diagnosed by sentinel lymph node biopsy during breast cancer surgery: a case report

Background

Concurrent breast cancer and malignant lymphoma is a rare phenomenon. This report describes malignant lymphoma that was incidentally diagnosed from a sentinel lymph node biopsy (SLNB) during breast cancer surgery.

Case presentation

A 73-year-old woman with a history of ovarian cancer and diabetes presented with right focal asymmetric density on a mammogram acquired during routine breast cancer screening. Ultrasonography (US) and magnetic resonance imaging (MRI) showed a 13.5-mm tumor in the upper lateral region of the right breast. A US-guided Mammotome biopsy revealed invasive ductal carcinoma of the right breast. Preoperative assessments including positron emission tomography–computerized tomography, found no evidence of axillary lymphadenopathy or distant metastasis. Because the breast cancer was stage I, the patient underwent a right mastectomy and a sentinel lymph node biopsy (SLNB) at our hospital. Pathological assessment of the biopsy revealed follicular lymphoma (FL), but no metastatic breast cancer. The patient was referred to hematology to stage the FL. Bone marrow findings were negative and stage I FL was diagnosed. After the mastectomy, she was monitored and given adjuvant therapy with an aromatase inhibitor.

Conclusions

Follicular lymphoma was incidentally diagnosed from an SLNB obtained to determine the dissemination of early-stage breast cancer. Collaboration with hematologists is important to determine optimal treatment plans for such patients regardless of the rarity of such events.

Failure of sentinel lymph node mapping in a patient with endometrial cancer with chronic lymphocytic leukemia: A case report

We aimed to report a detection failure of sentinel lymph node (SLN) mapping via indocyanine green in a patient with endometrial cancer with a previous history of chronic lymphocytic leukemia (CLL), which is a potential risk factor to obstruct lymphatic channels. A 64-year-old woman with a 12-year history of CLL presented to the clinic with grade 2 endometrioid carcinoma. The patient underwent laparoscopic surgical staging. Indocyanine green was used intraoperatively to locate the SLN. No lymph node or lymphatic vessels were identified during SLN mapping. At the final pathology, the morphological findings of CLL were detected in the lymph nodes without metastasis of endometrial cancer. Sentinel lymph node mapping failure due to obstruction of lymphatic channels in a patient with CLL was demonstrated in this study. This is the first report to the best of our knowledge showing SLN mapping failure in the presence of lymphoproliferative diseases.

Incidental discovery of follicular lymphoma by sentinel lymph node biopsy and skin-sparing mastectomy for Paget's disease associated with invasive breast cancer

In breast cancer surgery, establishing a diagnosis other than lymph node metastasis of breast cancer, when performing a sentinel node biopsy in individuals with breast cancer, is rare. Here, we report a case of incidental discovery of follicular lymphoma by sentinel lymph node biopsy for Paget's disease associated with invasive breast cancer. A 60-year-old female initially presented with erosion on her left nipple and was clinically diagnosed with stage IA human epidermal growth factor receptor type 2 (HER2)-positive breast cancer and Paget's disease. Accordingly, skin-sparing mastectomy, sentinel lymph node biopsy, and immediate breast reconstruction were performed. Although an intraoperative pathological examination of frozen sections of lymph nodes presented no evidence of metastasis, it revealed large follicles. Based on immunohistochemistry of the additional lymph nodes, she was diagnosed with follicular lymphoma. Therefore, we initiated chemotherapy for follicular lymphoma followed by trastuzumab. At present, 6 years after the operation for breast cancer, the patient is doing well.

Lymphatic mapping could not be impaired in the presence of breast carcinoma and coexisting small lymphocytic lymphoma

Patient: Female, 66

Final Diagnosis: Infiltrating ductal carcinoma • small lymphocytic lymphoma

Symptoms: —

Medication: —

Clinical Procedure: Sentinel Lymph Node Biopsy • lumpectomy • axillary lymph node dissection

Specialty: Breast cancer surgery