Contralateral lymph node metastasis in a woman with new primary breast cancer: Systemic desease or locoregional diffusion?

INTRODUCTION: Contralateral axillary lymph node metastases (CAMs) in patients with breast cancer are rare (Daoud et al., 1998); however, CAMs may be already detected at the time of primary breast cancer diagnosis (synchronous CAM) or after a previous treatment of breast cancer as a recurrence if not as an ipsilateral breast recurrence (IBR) (metasynchronous CAM) (Zhou and Richir, 2013). The involvement of the contralateral axilla could be caused by a systemic disease (stage IV), a regional metastasis from a new occult primary tumor (T0N1, stage II) or a breast cancer recurrence It may also arise from a locally advanced disease in a patient who has suffered from a primary breast cancer. PRESENTATION OF CASE: This report focuses on the case of a 50-year-old woman who has developed a new primary breast cancer, breast skin invasion and CAMs. DISCUSSION: We intend to show that an altered lymphatic drainage may result from CAMs; in fact, patients who have previously undergone axillary lymph node dissection (ALND) are more likely to develop contralateral lymph drainage (Maaskant-Braat et al., 2013). CONCLUSION: Along with that, we want to support the theory that CAMs should be treated with curative intent rather than as a stage IV disease, as we believe that CAMs are due to a locoregional extension of the disease.