08 May 2023 : Case report
[In Press] Surgical Treatment of a Patient with Breast Cancer Arising in the Pathway of a Ventriculoperitoneal Shunt: A Case Report
Unusual or unexpected effect of treatmentMasayuki Saito12ABCDEF, Shinji Kato2AEF, Takashi Maeda 2AEF, Kenichi Komaya2AEF, Takehiro Takagi2AEF, Atsushi Sekimura2AEF, Satoshi Kobayashi2ABCDEF, Akihiro Hori2AEF
Am J Case Rep In Press; DOI: 10.12659/AJCR.939639
Available online: 2023-05-08, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Ventriculoperitoneal shunt placement is a common neurosurgical procedure to treat hydrocephalus, but there are few reports of breast cancer occurring in the shunt’s pathway.
The patient was an 86-year-old woman. She visited our hospital because she became aware of a mass in her left breast. She had undergone ventriculoperitoneal (VP) shunt surgery for normal-pressure hydrocephalus. Palpation revealed an irregular mass at 9 o’clock of the left breast. Breast ultrasonography showed a mass with indistinct borders, rough margins, and skin infiltration with a maximum size of 36 mm at 9 o’clock of the left breast. The VP shunt tube was observed in the center of the mass. Core-needle biopsy was performed and the diagnosis was invasive ductal carcinoma and the subtype was triple-negative. Contrast-enhanced computed tomography showed that the ventriculoperitoneal shunt passed from the left ventricle through the center of the left breast mass and into the abdominal cavity. We were concerned about shunt occlusion and infection if the breast cancer was left untreated, so after consultation with the neurosurgeon, we performed the surgery. The ventriculoperitoneal shunt was rerouted from the left thoracoabdomen to the right thoracoabdomen. In addition to left mastectomy, the fistula in the abdominal wall was removed to prevent recurrence in the shunt’s path. Histopathology results showed invasive ductal carcinoma and the subtype was triple-negative. There were no malignant findings in the abdominal wall fistula.
The cases of distant metastasis of cancer caused by VP shunt have been reported. These events suggest that treatment of breast cancer arising in the VP shunt pathway should include additional procedures to prevent cancer seeding in addition to routine breast cancer surgery. In this case, we performed mastectomy, VP shunt rerouting, and abdominal wall fistulotomy.
Keywords: Breast Neoplasms; Mastectomy; Ventriculoperitoneal Shunt
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