Pulmonary Hilar Lymph Node Metastasis of Breast Cancer Induced Bronchopleural Fistula and Superior Vena Cava Syndrome

Patient: Female, 56 Final Diagnosis: Broncho-pleural fistula • empyema • supra-vena cava syndrome Symptoms: Dyspnea • fever • facial edema Medication: — Clinical Procedure: — Specialty: Oncology and Pulmonology OBJECTIVE: Unusual clinical course BACKGROUND: It is extremely rare for pulmonary hilar lymph node metastasis (PHLNM) of a cancer to be independently lethal. Here, we report an exceedingly rare case of cavitation in PHLNM from breast cancer triggering bronchopleural fistula and empyema (BPFE), complicated with superior vena cava syndrome (SVCS). CASE REPORT: A 56-year-old woman who had undergone left segmental mastectomy and axillary lymph node dissection due to left breast cancer was then treated for 1 year with postoperative adjuvant chemotherapy. Recurrence of right PHLNM was observed 2 years after the operation, for which 3 courses of bevacizumab (BEV) and paclitaxel combination chemotherapy were administered. The woman had dyspnea and fever during the washout period, and CT examination revealed fistula formation between the right PHLNM cavitation and right main bronchus, so she was admitted for further treatment. This fistula rapidly progressed to BPFE, and contralateral aspiration was observed to cause pneumonia of the left lung. In addition, edema of both upper limbs and head and neck were observed, and CT examination revealed SVCS caused by re-enlargement of PHLNM. Active treatment was performed, but the recommencement of chemotherapy was not possible, and she died on Day 150 of admission. CONCLUSIONS: We think that PHLNM deteriorated to central necrosis due to chemotherapy with BEV taking effect, leading to formation of BPFE. The case was also made more difficult due to the complication of SVCS caused by the re-enlarged PHLNM.