Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2025; 13(18): 103571
Published online Jun 26, 2025. doi: 10.12998/wjcc.v13.i18.103571
Unexpected contralateral axillary lymph node metastasis without ipsilateral involvement in triple-negative breast cancer: A case report and review of literature
Yun-Ting Lin, Zhi-Jie Hong, Guo-Shiou Liao, Ming-Shen Dai, Tai-Kuang Chao, Wen-Chiuan Tsai, Yu-Kai Sung, Chuang-Hsin Chiu, Cheng-Kuang Chang, Jyh-Cherng Yu
Yun-Ting Lin, Department of General Medicine, Tri Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Zhi-Jie Hong, Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Guo-Shiou Liao, Jyh-Cherng Yu, Division of General Surgery, Department of Surgery, Tri Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Ming-Shen Dai, Division of Hematology/Oncology, Department of Internal Medicine, National Defense Medical Center, Taipei 114, Taiwan
Tai-Kuang Chao, Yu-Kai Sung, Department of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Wen-Chiuan Tsai, Department of Pathology, National Defense Medical Center, Taipei 114, Taiwan
Chuang-Hsin Chiu, Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Cheng-Kuang Chang, Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Co-corresponding authors: Zhi-Jie Hong and Jyh-Cherng Yu.
Author contributions: Hong ZJ and Yu JC contribute equally to this stud as co-corresponding author; Lin YT reviewed the literature and contributed to manuscript as first author; Hong ZJ contributed to this study as corresponding authors and reviewed the article; Liao GS reviewed the article; Dai MS is an oncologist and drew up chemotherapy for the patient; Chao TK, Tsai WC and Sung YK are the pathologists and interpreted the pathological reports; Chiu CH is a nuclear medicine radiologist and interpreted the positron emission tomography computed tomography scan; Chang CK is a radiologist and interpreted the images; Yu JC is the patient’s surgeon; Yu JC conceptualized and designed the manuscript, critically revised the manuscript, and approved the final version for submission.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images. This study was approved by the Institutional Review Board (IRB) of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, and complied with relevant guidelines (IRB: B202415203, date of approval 19 November 2024).
Conflict-of-interest statement: The authors declare no conflicts of interest or competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Jie Hong, MD, PhD, Assistant Professor, Chief Physician, Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325 Section 2, Chenggong Road, Neihu District, Taipei 114, Taiwan. lgf670822@mail.ndmctsgh.edu.tw
Received: December 9, 2024
Revised: January 15, 2025
Accepted: January 24, 2025
Published online: June 26, 2025
Processing time: 82 Days and 18.9 Hours
Abstract
BACKGROUND

Breast cancer is a leading cause of cancer-related mortality among women worldwide, with invasive ductal carcinoma (IDC) being the most prevalent subtype. Lymph node metastasis is the primary prognostic indicator, typically evaluated via biopsy of the ipsilateral sentinel or axillary lymph nodes. Contralateral axillary metastasis (CAM) without ipsilateral involvement is exceedingly rare, particularly in early-stage breast cancer. This report presents a case of CAM in a patient with triple-negative breast cancer (TNBC), underscoring diagnostic and therapeutic complexities.

CASE SUMMARY

A 73-year-old female presented with left-sided early-stage IDC in February 2023. Despite a modified radical mastectomy and pathologically negative ipsilateral lymph nodes, a postoperative positron emission tomography (PET) scan detected fluorodeoxyglucose-avid nodes in the contralateral axilla. Biopsy confirmed metastatic ductal carcinoma with triple-negative status, resulting in an upstaged diagnosis of metastatic breast cancer, stage IV, M1. The patient underwent six cycles of adjuvant chemotherapy, with follow-up PET imaging showing regression of the contralateral lesion. This case highlights the importance of advanced imaging in TNBC for precise staging and treatment optimization.

CONCLUSION

This case highlights the aggressive nature of TNBC and the need for advanced imaging to ensure accurate staging and effective management.

Keywords: Triple negative breast neoplasms; Invasive ductal carcinoma; Lymphatic metastasis; Contralateral axillary metastasis; Positron-emission tomography; Case report

Core Tip: We present a 73-year-old female with triple-negative breast cancer (TNBC) exhibiting contralateral axillary lymph node metastasis without ipsilateral involvement. Despite early-stage diagnosis and modified radical mastectomy, positron emission tomography (PET) imaging and biopsy later upstaged the disease to metastatic stage IV. This case highlights the aggressive nature of TNBC, its complex lymphatic spread, the potential utility of PET scans for accurate staging in high-risk early breast cancers and treatment for contralateral axillary metastasis. These findings suggest reconsidering mandatory PET imaging for early TNBC or other high-risk cases to ensure accurate staging and optimal systemic therapy for improved outcomes.