J Korean Soc Radiol.  2011 May;64(5):515-518. 10.3348/jksr.2011.64.5.515.

Traumatic Neuroma in a Breast Cancer Patient After Modified Radical Mastectomy: A Case Report

• Kim EY
• Kang DK
• Kim TH
• Kim KS
• Yim H

• KMID: 2040822
• DOI: http://doi.org/10.3348/jksr.2011.64.5.515

Abstract

Traumatic neuromas are rare benign lesions that develop from non-neoplastic proliferation of axons, schwann cells, and fibroblasts at the proximal end of transected or injured nerves as a result of trauma or surgery. We present the case of a traumatic neuroma in a 47-year-old female who was treated with a right modified radical mastectomy for breast cancer 14 years ago. Ultrasound examination revealed an oval-shaped hypoechoic nodule at the 9-o'clock position in the right chest wall. Color Doppler imaging showed no increased blood flow and a positron emission tomography-computed tomography examination revealed no fluorodeoxyglucose uptake in this nodule. The typical histologic findings were present.

MeSH Terms

Axons
Breast
Breast Neoplasms
Electrons
Female
Fibroblasts
Humans
Mastectomy, Modified Radical
Middle Aged
Neuroma
Schwann Cells
Thoracic Wall

Figure

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  Fig. 1 Ultrasound examination. A. Longitudinal sonogram of the 9 o' clock position of the right chest wall shows an oval-shaped, hypoechoic mass with a circumscribed and partially microlobulated margin (arrow). B. Transverse sonogram also reveals a partially microlobulated margin (arrow). This nodule is located within the pectoralis muscle layer.

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  Fig. 2 Axial scan of PET-CT reveals no focal uptake area in the outer portion of the right chest wall (arrow). We can see mild atrophic changes of the outer portion of the right pectoralis major compared with the left side.

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  Fig. 3 Microscopic findings. A. Microscopic specimen of the breast lesions shows disordered and irregularly proliferating nerve fascicles (arrows) surrounded by fibro-adipose tissues (hematoxylin eosin stain, original magnification ×100). B. At higher magnification, some hyperplastic nerve bundles are composed of axons, schwann cells, and fibroblasts (original magnification ×400).

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  Fig. 4 Schematic drawing showing anatomic location of nerves around the pectoralis muscle. Lateral and medial pectoral nerves, and lateral and anterior cutaneous branches from intercostal nerves are closely located with the pectoralis major muscle. Lateral pectoral nerve (arrow) originates from the C5-6 roots, moves inferolaterally through the clavipectoral fascia, and supplies inferior and lateral portion of the pectoralis major. Medial pectoral nerve (large arrow) originates from C8-T1 and mainly enters the deep surface of the pectoralis minor muscle. Lateral (open arrow) and anterior (arrow head) cutaneous branches of the intercostal nerve run on the pectoralis major muscle and supply the skin and mammary tissue.

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