Aggravated Primary Lymphedema of Contralateral Upper Limb after the Radical Mastectomy: A Case Report

Aggravated Primary Lymphedema of Contralateral Upper Limb after the Radical Mastectomy: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Case report Aggravated Primary Lymphedema of Contralateral Upper Limb after the Radical Mastectomy: A Case Report Ying Liu, Weiren Pan, Jinghong Guan, Xiao Long This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-42728/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Breast cancer-related lymphedema is usually characterized by edema of the affected the ipsilateral upper limb and trunk. We report a case of aggravated primary lymphedema in the contralateral limb and trunk after breast cancer resection and axillary lymph node dissection. Case presentation: A 63-year-old female developed right thorax-back and upper limb swelling since childhood. After the modified mastectomy, the swelling of her right chest, back and upper limb increased. While she had no edema of left torso and limb. There was no relevant supplementary examination data because she refused to take lymphoscintigraphy or MRI scan. However, according to her medical history and physical examination, she was preliminarily diagnosed as primary lymphedema, International Society of lymphedema stage 2. Conclusions: Primary lymphedema and secondary lymphedema may be both results of the interaction of multiple factors and can be induced or aggravated by trauma, surgery or other reasons besides the abnormal lymphatic development of individuals. Oncology primary lymphedema breast cancer-related lymphedema secondary lymphedema Figures Figure 1 Figure 2 Figure 3 Background Lymphedema can be classified into primary and secondary types. Primary lymphedema (PLE) is due to a developmental defect of (malformation, dysplasia) of the lymph vessels and/or lymph nodes. PLE can be developed if minor surgery is performed in a region of the body in which the transport capacity is subnormal because of dysplasia of the lymph vessels. Breast cancer-related lymphedema (BCRL) is a common secondary lymphedema (SLE). It can be seen in the affected upper limb often after axillary lymph nodes dissection (ALND)(28.2%)or sometimes after sentinel lymph node biopsy (SLNB) (5.6%) [ 1 ] . Although there have been a few reports indicating that BCRL may affect the clinically “normal” contralateral arm, only exacerbation of lymphedema in the contralateral trunk and upper limb while no obvious edema in the affected upper limb was seldom addressed before. In this report, we describe a patient who underwent progressive PLE in the right trunk and upper limb after left radical mastectomy. Case Presentation A 63-year-old female visited the clinic of the Peking Union Medical College Hospital for her right thoracic back and upper limb edema. She developed right thorax-back and upper limb swelling since childhood, and upper limb swelling was confined to her right hand and wrist. She received modified mastectomy for left breast cancer one year ago in a local hospital. Her left axillary lymph node was removed. Six months after the operation, the swelling of her right chest, back and upper limb gradually increased, and the swelling of her right forearm and upper arm appeared. In recent one month, the edema was markedly aggravated, and the skin of upper arm and forearm became stiff with exudation of right nipple. She had no complaints of swelling of left torso and limb, pain and numbness of right limb. Her past medical history did not reveal any relevant disease related to arm swelling. Her family history was unremarkable for any similar illness. On physical examination, the right thorax-back, upper limb and hand were markedly swollen. The skin of the right upper limb was stiff, and yellowish transparent water-like exudate could be seen in the right nipple. There was no visible swelling in the left chest, back and upper limb, as shown in the following figure. Examination of bilateral lower extremities were completely normal. She refused to take lymphoscintigraphy or MRI scan as a provincial patient without medical insurance. So we haven't got the relevant supplementary examination data. However, according to her medical history and physical examination, she was preliminarily diagnosed as PLE, International Society of lymphedema (ISL) stage 2. Discussion And Conclusion PLE can occur at an early age and can also be triggered by trauma, surgery or other reasons. BCRL is a common SLE, usually confined to the affected upper limb or and thorax-back. The traditional view of BCRL pathophysiology is that removal of axillary nodes results in obstruction to the flow of lymph from the arm, leading to accumulation of protein-rich fluid in the interstitium: the‘stopcock’ hypothesis. But some women develop BCRL after sentinel node biopsy, whereas others do not after clearance surgery, which suggest that a simple ‘stopcock’ mechanism does not explain many clinical aspects, including the delayed onset and selective sparing of some regions, e.g, hand. BCRL is a result of interaction between several pathophysiological processes, and is not simply a ‘stopcock’ effect resulting from removal of axillary lymph nodes [ 2 ] . Predisposition hypothesis has therefore attracted the attention of some researchers. Aldrich found the appearance of vessel abnormalities on unaffected arms with increasing time which indicated that BCRL might progress to affect the clinically “normal” arm and become a systemic, rather than local, malady. So care should be given to both arms after cancer treatment [ 3 ] .In other two studies, rates of depot clearance after subcutaneous injection of radiolabeled protein in the hands and subsequent appearance in venous blood suggested lymphatic dysfunction in both affected and contralateral “normal” arms [ 4 , 5 ] . Bains found that women with upper-limb BCRL had reduced lower-limb lymphatic function and a large proportion of women with breast cancer had abnormal lower-limb lymphatic function, irrespective of whether they had symptoms of upper-limb BCRL or not. Possible explanations could be a systemic effect of breast cancer or its treatment, or an unidentified association between breast cancer and lymphatic dysfunction. There is a constitutional ‘global’ lymphatic dysfunction in patients who develop BCRL [ 6 ] .Furthermore, the risk factors of BCRL are multiple. A genetic predisposition for lymphatic dysfunction, other surgical or injury damage to lymphatics, body mass index, medications, and fitness level are all suspected systemic factors contributing to the development of lymphedema [ 7 , 8 ] . In addition, WeiRen Pan found that the individualization of lymphatic system development varies greatly [ 9 ] . The clinical symptoms and signs of lymphedema are related to the anatomical differences of individual lymphatic system. The special point of this case was that radical mastectomy aggravated the original lymphedema of trunk and upper limb, but it only occurred in the opposite side of the operation. In addition to the above predisposing hypothesis and cancer treatment could trigger or aggravate systemic edema, the individual differences of lymphatic dysplasia and the resection or damage of lymphatic vessels and lymph nodes in the affected trunk and upper extremities after surgery should also be taken into account. And the lymph flow of the affected side might be past sagital watershed and be reversed toward the opposite side, thus leading to the progressive PLE of the unaffected trunk and upper limb. Bobbio had ever reported the similar situation, as showed in the following figure. To summarize, PLE and SLE may be both results of the interaction of multiple factors. Tumor itself or cancer treatment may induce or aggravate SLE in susceptible patients. PLE can be induced or aggravated by trauma, surgery or other reasons besides the abnormal lymphatic development of individuals, and may be manifested differently according to the specific conditions of individual lymphatic abnormalities. Further studies need to determine whether systemic manifestation of lymphatic abnormalities in cancer-related lymphedema are indicative of progressive disease and their relationship with cancer treatment. Abbreviations PLE： Primary lymphedema BCRL： Breast cancer-related lymphedema SLE： Secondary lymphedema ALND： Axillary lymph nodes dissection SLNB： Sentinel lymph node biopsy ISL: International Society of lymphedema Declarations Availability of data and materials N/A. Acknowledgements The authors would like to thank the patient for her kind cooperation in our study. Funding This study did not receive any funding by any governmental or private organization. Author information Affiliations Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China Ying Liu, Weiren pan, Jinghong Guan and Xiao Long Contributions Ying Liu had substantial contributions to the work including the acquisition, analysis, and interpretation of data, drafting and revising the manuscript. Weiren pan aided in revising the manuscript critically for important intellectual content and polishing the language of English. Jinghong Guan was in charge of clinical diagnosis and evaluation of breast cancer of this case and polishing the language of English. Xiao Long was responsible for diagnosis and evaluation of lymphedema of this case, design of the work, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, And all authors have read and approved the manuscript. Corresponding author Correspondence to Dr. Xiao Long. Ethics declarations Ethics approval and consent to participate Written and informed consent was obtained from the patient for the publication of this study; moreover, no patient health identification (PHI) was recorded. Consent for publication The patient gave her written informed consent for the publication of her data. Competing interests Drs. Ying Liu, Weiren pan, Jinghong Guan and Xiao Long had no competing interests or financial ties to disclose. References 1.DiSipio T, Rye S, Newman B, et al. Incidence of unilateral arm lymphoedema after breast cancer: A systematic review and meta-analysis. Lancet Oncol2013,14(6):500–515. 2.Stanton AW, Modi S, Mellor RH, Levick JR, Mortimer PS. Recent advances in breast cancer-related lymphedema of the arm: lymphatic pump failure and predisposing factors. Lymphat Res Biol 2009,7(1): 29–45. 3.Melissa B. Aldrich, RenieGuilliod, Caroline E. Fife, et al. Lymphatic abnormalities in the normal contralateral arms of subjects with breast cancer-related lymphedema as assessed by near-infrared fluorescent imaging.Biomed Opt Express2012, 3(6): 1256-1265. S. J. Pain, R. W. Barber, J. R. Ballinger, et al. Local vascular access of radioprotein injected subcutaneously in healthy subjects and patients with breast cancer-related lymphedema. J Nucl Med 2004, 45(5): 789–796. S. J. Pain, A. D. Purushotham, R. W. Barber, et al. Variation in lymphatic function may predispose to development of breast cancer-related lymphoedema. Eur J SurgOncol 2004,30(5):508–514. S. K. Bains, A. M. Peters, C. Zammit, et al. Global abnormalities in lymphatic function following systemic therapy in patients with breast cancer. Br JSurg 2015, 102(5): 534–540. S. H. Ridner, M. S. Dietrich, B. R. Stewart, J. M. Armer. Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer 2011,19(6): 853–857. 8.M. L. Kwan, J. Darbinian, K. H. Schmitz, et al. Risk factors for lymphedema in a prospective breast cancer survivorship study: the Pathways Study.ArchSurg 2010,145(11): 1055–1063. 9.Wei-Ren Pan.Atlasof lymphaticanatomy in the head, neck chest and limbs.People’s Medical Publishing House.2017:176. 10. P.Bobbio,G. Peracchia, F. Pellegriano. Connessionilinfatichepresternalifra le regioni mammary dei due lati, AteneoParmense 33 (supp) (1962): 95-109. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-42728","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case report","associatedPublications":[],"authors":[{"id":875682,"identity":"5f255a84-dd91-4c34-9796-0548efc7b92f","order_by":0,"name":"Ying Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYBACCWYQWSDBwM/A2ECsFpAeAwkGyQaitTCAtQDRAWIdJtnOf/ABg4FF4ubzh9se/GCwk9MlZJk0MzOzAdBhidtuJLYb9jAkG5sRsk6OmZlNAqKFsU2Ch+FA4jYitLD/AGnZ3H+wTfIPMVqADmMDhVjiBobENmmibJFsZjYGOcx4xg2gFhkDIvwicf7gww8MFXWy/f3Hn0m+qbCTI6gFBJj/wJkGRCgfBaNgFIyCUUAYAAAxsjZVdHWWWwAAAABJRU5ErkJggg==","orcid":"","institution":"Peking Union Medical College Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Liu","suffix":""},{"id":875683,"identity":"d5130dc1-2063-4a34-b569-a7dcf460cb60","order_by":1,"name":"Weiren Pan","email":"","orcid":"","institution":"Xuzhou Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Weiren","middleName":"","lastName":"Pan","suffix":""},{"id":875684,"identity":"c1d7eb2a-ec85-4dd7-9435-68e8a7f21124","order_by":2,"name":"Jinghong Guan","email":"","orcid":"","institution":"Peking Union Medical College Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jinghong","middleName":"","lastName":"Guan","suffix":""},{"id":875685,"identity":"95eb8a97-c7a9-4c13-9a95-0a9c798518f1","order_by":3,"name":"Xiao Long","email":"","orcid":"","institution":"Peking Union Medical College Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Long","suffix":""}],"badges":[],"createdAt":"2020-07-14 03:36:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-42728/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-42728/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":1624990,"identity":"f0726844-271c-4533-ad1c-c4cf57ac9d39","added_by":"auto","created_at":"2020-07-20 19:17:53","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":31111,"visible":true,"origin":"","legend":"Anterior view of trunk and upper limb. Postoperative changes of left chest after mastectomy. Swelling of the right thorax, upper limb and hand and normal left upper limb.","description":"","filename":"Figure1.JPG","url":"https://assets-eu.researchsquare.com/files/rs-42728/v1/Figure1.JPG"},{"id":1624991,"identity":"208caea4-c5dd-4073-844e-690e85199edb","added_by":"auto","created_at":"2020-07-20 19:17:53","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":26698,"visible":true,"origin":"","legend":"Posterior view oftrunk and upper limb. Swelling of the rightback, upper limb and hand and normal left back and upper limb.","description":"","filename":"Figure2.JPG","url":"https://assets-eu.researchsquare.com/files/rs-42728/v1/Figure2.JPG"},{"id":1624992,"identity":"4db33846-b3e1-45c3-9d22-f44b091f079c","added_by":"auto","created_at":"2020-07-20 19:17:53","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":46507,"visible":true,"origin":"","legend":"External connections between the mammary regions on both sides.\nP.Bobbio,G. Peracchia, F. Pellegriano, Connessioni linfatiche presternalifra le regioni mammary dei due lati, AteneoParmense 33 (supp) (1962)95-109.","description":"","filename":"Figure3.JPG","url":"https://assets-eu.researchsquare.com/files/rs-42728/v1/Figure3.JPG"},{"id":13554269,"identity":"5faa35b6-d06f-4104-ae81-362f1e0dc440","added_by":"auto","created_at":"2021-09-17 02:40:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":299690,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-42728/v1/ceb44f0b-c786-40a3-8e85-b27a7d7df9cc.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eAggravated Primary Lymphedema of Contralateral Upper Limb after the Radical Mastectomy: A Case Report\u003c/p\u003e","fulltext":[{"header":"Background","content":" \u003cp\u003eLymphedema can be classified into primary and secondary types. Primary lymphedema (PLE) is due to a developmental defect of (malformation, dysplasia) of the lymph vessels and/or lymph nodes. PLE can be developed if minor surgery is performed in a region of the body in which the transport capacity is subnormal because of dysplasia of the lymph vessels. Breast cancer-related lymphedema (BCRL) is a common secondary lymphedema (SLE). It can be seen in the affected upper limb often after axillary lymph nodes dissection (ALND)(28.2%)or sometimes after sentinel lymph node biopsy (SLNB) (5.6%) \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Although there have been a few reports indicating that BCRL may affect the clinically \u0026ldquo;normal\u0026rdquo; contralateral arm, only exacerbation of lymphedema in the contralateral trunk and upper limb while no obvious edema in the affected upper limb was seldom addressed before. In this report, we describe a patient who underwent progressive PLE in the right trunk and upper limb after left radical mastectomy.\u003c/p\u003e "},{"header":"Case Presentation","content":" \u003cp\u003eA 63-year-old female visited the clinic of the Peking Union Medical College Hospital for her right thoracic back and upper limb edema. She developed right thorax-back and upper limb swelling since childhood, and upper limb swelling was confined to her right hand and wrist. She received modified mastectomy for left breast cancer one year ago in a local hospital. Her left axillary lymph node was removed. Six months after the operation, the swelling of her right chest, back and upper limb gradually increased, and the swelling of her right forearm and upper arm appeared. In recent one month, the edema was markedly aggravated, and the skin of upper arm and forearm became stiff with exudation of right nipple. She had no complaints of swelling of left torso and limb, pain and numbness of right limb. Her past medical history did not reveal any relevant disease related to arm swelling. Her family history was unremarkable for any similar illness. On physical examination, the right thorax-back, upper limb and hand were markedly swollen. The skin of the right upper limb was stiff, and yellowish transparent water-like exudate could be seen in the right nipple. There was no visible swelling in the left chest, back and upper limb, as shown in the following figure.\u003c/p\u003e \u003cp\u003eExamination of bilateral lower extremities were completely normal.\u003c/p\u003e \u003cp\u003eShe refused to take lymphoscintigraphy or MRI scan as a provincial patient without medical insurance. So we haven't got the relevant supplementary examination data. However, according to her medical history and physical examination, she was preliminarily diagnosed as PLE, International Society of lymphedema (ISL) stage 2.\u003c/p\u003e "},{"header":"Discussion And Conclusion","content":" \u003cp\u003ePLE can occur at an early age and can also be triggered by trauma, surgery or other reasons. BCRL is a common SLE, usually confined to the affected upper limb or and thorax-back. The traditional view of BCRL pathophysiology is that removal of axillary nodes results in obstruction to the flow of lymph from the arm, leading to accumulation of protein-rich fluid in the interstitium: the\u0026lsquo;stopcock\u0026rsquo; hypothesis. But some women develop BCRL after sentinel node biopsy, whereas others do not after clearance surgery, which suggest that a simple \u0026lsquo;stopcock\u0026rsquo; mechanism does not explain many clinical aspects, including the delayed onset and selective sparing of some regions, e.g, hand. BCRL is a result of interaction between several pathophysiological processes, and is not simply a \u0026lsquo;stopcock\u0026rsquo; effect resulting from removal of axillary lymph nodes\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Predisposition hypothesis has therefore attracted the attention of some researchers. Aldrich found the appearance of vessel abnormalities on unaffected arms with increasing time which indicated that BCRL might progress to affect the clinically \u0026ldquo;normal\u0026rdquo; arm and become a systemic, rather than local, malady. So care should be given to both arms after cancer treatment\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.In other two studies, rates of depot clearance after subcutaneous injection of radiolabeled protein in the hands and subsequent appearance in venous blood suggested lymphatic dysfunction in both affected and contralateral \u0026ldquo;normal\u0026rdquo; arms\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Bains found that women with upper-limb BCRL had reduced lower-limb lymphatic function and a large proportion of women with breast cancer had abnormal lower-limb lymphatic function, irrespective of whether they had symptoms of upper-limb BCRL or not. Possible explanations could be a systemic effect of breast cancer or its treatment, or an unidentified association between breast cancer and lymphatic dysfunction. There is a constitutional \u0026lsquo;global\u0026rsquo; lymphatic dysfunction in patients who develop BCRL\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.Furthermore, the risk factors of BCRL are multiple. A genetic predisposition for lymphatic dysfunction, other surgical or injury damage to lymphatics, body mass index, medications, and fitness level are all suspected systemic factors contributing to the development of lymphedema\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition, WeiRen Pan found that the individualization of lymphatic system development varies greatly\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The clinical symptoms and signs of lymphedema are related to the anatomical differences of individual lymphatic system.\u003c/p\u003e \u003cp\u003eThe special point of this case was that radical mastectomy aggravated the original lymphedema of trunk and upper limb, but it only occurred in the opposite side of the operation. In addition to the above predisposing hypothesis and cancer treatment could trigger or aggravate systemic edema, the individual differences of lymphatic dysplasia and the resection or damage of lymphatic vessels and lymph nodes in the affected trunk and upper extremities after surgery should also be taken into account. And the lymph flow of the affected side might be past sagital watershed and be reversed toward the opposite side, thus leading to the progressive PLE of the unaffected trunk and upper limb. Bobbio had ever reported the similar situation, as showed in the following figure.\u003c/p\u003e \u003cp\u003eTo summarize, PLE and SLE may be both results of the interaction of multiple factors. Tumor itself or cancer treatment may induce or aggravate SLE in susceptible patients. PLE can be induced or aggravated by trauma, surgery or other reasons besides the abnormal lymphatic development of individuals, and may be manifested differently according to the specific conditions of individual lymphatic abnormalities. Further studies need to determine whether systemic manifestation of lymphatic abnormalities in cancer-related lymphedema are indicative of progressive disease and their relationship with cancer treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePLE：\u003c/p\u003e\n\u003cp\u003ePrimary lymphedema\u003c/p\u003e\n\u003cp\u003eBCRL：\u003c/p\u003e\n\u003cp\u003eBreast cancer-related lymphedema\u003c/p\u003e\n\u003cp\u003eSLE：\u003c/p\u003e\n\u003cp\u003eSecondary lymphedema\u003c/p\u003e\n\u003cp\u003eALND：\u003c/p\u003e\n\u003cp\u003eAxillary lymph nodes dissection\u003c/p\u003e\n\u003cp\u003eSLNB：\u003c/p\u003e\n\u003cp\u003eSentinel lymph node biopsy\u003c/p\u003e\n\u003cp\u003eISL:\u003c/p\u003e\n\u003cp\u003eInternational Society of lymphedema\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN/A.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the patient for her kind cooperation in our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any funding by any governmental or private organization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAffiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePeking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China\u003c/p\u003e\n\u003cp\u003eYing Liu, Weiren pan, Jinghong Guan and Xiao Long\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYing Liu had substantial contributions to the work including the acquisition, analysis, and interpretation of data, drafting and revising the manuscript. Weiren pan aided in revising the manuscript critically for important intellectual content and polishing the language of English. Jinghong Guan was in charge of clinical diagnosis and evaluation of breast cancer of this case and polishing the language of English. Xiao Long was responsible for diagnosis and evaluation of lymphedema of this case, design of the work, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, And all authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Dr. Xiao Long.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eWritten and informed consent was obtained from the patient for the publication of this study; moreover, no patient health identification (PHI) was recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient gave her written informed consent for the publication of her data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDrs. Ying Liu, Weiren pan, Jinghong Guan and Xiao Long had no competing interests or financial ties to disclose.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1.DiSipio T, Rye S, Newman B, et al. Incidence of unilateral arm lymphoedema after breast cancer: A systematic review and meta-analysis. Lancet Oncol2013,14(6):500\u0026ndash;515.\u003c/p\u003e\n\u003cp\u003e2.Stanton AW, Modi S, Mellor RH, Levick JR, Mortimer PS. Recent advances in breast cancer-related lymphedema of the arm: lymphatic pump failure and predisposing factors. Lymphat Res Biol 2009,7(1): 29\u0026ndash;45.\u003c/p\u003e\n\u003cp\u003e3.Melissa B. Aldrich, RenieGuilliod, Caroline E. Fife, et al. Lymphatic abnormalities in the normal contralateral arms of subjects with breast cancer-related lymphedema as assessed by near-infrared fluorescent imaging.Biomed Opt Express2012, 3(6): 1256-1265.\u003c/p\u003e\n\u003col start=\"4\"\u003e\n\u003cli\u003eS. J. Pain, R. W. Barber, J. R. Ballinger, et al. Local vascular access of radioprotein injected subcutaneously in healthy subjects and patients with breast cancer-related lymphedema. J Nucl Med 2004, 45(5): 789\u0026ndash;796.\u003c/li\u003e\n\u003cli\u003eS. J. Pain, A. D. Purushotham, R. W. Barber, et al. Variation in lymphatic function may predispose to development of breast cancer-related lymphoedema. Eur J SurgOncol 2004,30(5):508\u0026ndash;514.\u003c/li\u003e\n\u003cli\u003eS. K. Bains, A. M. Peters, C. Zammit, et al. Global abnormalities in lymphatic function following systemic therapy in patients with breast cancer. Br JSurg 2015, 102(5): 534\u0026ndash;540.\u003c/li\u003e\n\u003cli\u003eS. H. Ridner, M. S. Dietrich, B. R. Stewart, J. M. Armer. Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer 2011,19(6): 853\u0026ndash;857.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e8.M. L. Kwan, J. Darbinian, K. H. Schmitz, et al. Risk factors for lymphedema in a prospective breast cancer survivorship study: the Pathways Study.ArchSurg 2010,145(11): 1055\u0026ndash;1063.\u003c/p\u003e\n\u003cp\u003e9.Wei-Ren Pan.Atlasof lymphaticanatomy in the head, neck chest and limbs.People\u0026rsquo;s Medical Publishing House.2017:176.\u003c/p\u003e\n\u003cp\u003e10. P.Bobbio,G. Peracchia, F. Pellegriano. Connessionilinfatichepresternalifra le regioni mammary dei due lati, AteneoParmense 33 (supp) (1962): 95-109.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"primary lymphedema, breast cancer-related lymphedema, secondary lymphedema","lastPublishedDoi":"10.21203/rs.3.rs-42728/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-42728/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u0026nbsp;Breast cancer-related lymphedema is usually characterized by edema of the affected the ipsilateral upper limb and trunk. We report a case of aggravated primary lymphedema in the contralateral limb and trunk after breast cancer resection and axillary lymph node dissection.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCase presentation: \u003c/strong\u003eA 63-year-old female developed right thorax-back and upper limb swelling since childhood. After the modified mastectomy, the swelling of her right chest, back and upper limb increased. While she had no edema of left torso and limb. There was no relevant supplementary examination data because she refused to take lymphoscintigraphy or MRI scan. However, according to her medical history and physical examination, she was preliminarily diagnosed as primary lymphedema, International Society of lymphedema stage 2.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\u003cp\u003ePrimary lymphedema and secondary lymphedema may be both results of the interaction of multiple factors and can be induced or aggravated by trauma, surgery or other reasons besides the abnormal lymphatic development of individuals.\u003c/p\u003e","manuscriptTitle":"Aggravated Primary Lymphedema of Contralateral Upper Limb after the Radical Mastectomy: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-07-20 19:17:52","doi":"10.21203/rs.3.rs-42728/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5746f972-f0e5-41b6-a820-1109c508fd65","owner":[],"postedDate":"July 20th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":176609,"name":"Oncology"}],"tags":[],"updatedAt":"2020-07-20T19:17:52+00:00","versionOfRecord":[],"versionCreatedAt":"2020-07-20 19:17:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-42728","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-42728","identity":"rs-42728","version":["v1"]},"buildId":"oE6Zbj460LM0Up2FdVbMZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}