Unusual Axillary Recurrence Observed in Breast Cancer With Bloody Nipple Discharge: A Case Report

After breast cancer surgery, a major part of axillary recurrences occur in lymph nodes. We report a case of breast cancer in which bloody nipple discharge spillage onto the surgical field was possibly associated with axillary recurrence. A 47-year-old woman with a history of mastectomy and sentinel node biopsy noticed an axillary mass. Her luminal breast cancer had been detected by bloody nipple discharge and pathologically diagnosed as a predominantly intraductal carcinoma seven years before. The axillary lesion was depicted as an oval mass both with indistinct margins and predominant internal high echoes on ultrasound. Magnetic resonance imaging of the mass showed slightly low signals on T1-weighted images and faint high signals on fat-suppressed T2-weighted images. Positron emission tomography showed no avid fluorodeoxyglucose uptake in the axillary mass. Due to the proven cytological malignancy of the axillary mass, the patient underwent salvage axillary dissection under the tentative diagnosis of axillary node recurrence. Post-operative pathological study, however, showed that the mass had atypical cells growing in cribriform and tubular fashions in the fibro-fatty tissue and did not have any lymph node structures, noninvasive cancer components, lympho-vascular involvement, normal mammary gland components, and metastatic foci in the dissected lymph nodes. These results suggested an association between bloody nipple discharge spillage onto the surgical field and axillary recurrence. The patient has been well on adjuvant leuprorelin and letrozole therapy for six months. Breast surgeons should note that bloody nipple discharge spillage during the operation may be a risk factor for local recurrence.