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\title{Early Contralateral Intramammary Lymph Node Metastasis Presented Soon after Mastectomy in Nigeria: Case Report}
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\begin{document}

             \author[1]{Wilson IB  Onuigbo}

             \affil[1]{  University of Nigeria Teaching Hospital}

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\date{\small \em Received: 15 December 2016 Accepted: 3 January 2017 Published: 15 January 2017}

\maketitle


\begin{abstract}
        


Mastectomy is an event that needs follow up. In this community, a report concerned recurrence in the mastectomy scar itself. Therefore, the present paper deals with metastasis beyond the midline itself, namely, spread across to an intramammary lymph node. It is considered here that interest in this location has long been delayed although its very existence was known as far back as 1892.

\end{abstract}


\keywords{breast, cancer, mastectomy, metastasis, intramammary node, contralateral, spread, 1892 history.}

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\let\tabcellsep& 	 	 		 
\section[{I. Introduction}]{I. Introduction}\par
reast cancer is a subject of consuming interest worldwide from several angles \hyperref[b0]{(1,}\hyperref[b1]{2)}. The senior author's interest was first aroused in this area with the epidemiology of breast masses among the local adolescents (3). Historical aspects also followed \hyperref[b3]{(4,} {\ref 5)}. In terms of malignancy, the importance of follow up after mastectomy was appreciated \hyperref[b5]{(6)}. Little wonder that our interest flowered with regard to the present case. 
\section[{II. Case Report}]{II. Case Report}\par
NEG, 36-year-old, Para 4 woman consulted the junior author (HEO) at the University of Nigeria Teaching Hospital, Enugu. She complained of ulcerative lesion in the left breast of 8 months' duration. Therefore, she underwent mastectomy. At follow up, after 4 months, there was a nodule in the right breast. After the usual investigations, it was biopsied.\par
When the specimen was received by the senior author (WIBO), it was a 3 cm ovoid, smooth surfaced mass. On section, it exhibited pale and darker areas. After routine processing, the lesion turned out to be a lymph node which proved to be the seat of metastatic cancer cells that formed glands typically. The Figure shows that both early subcapsular and deeper parenchymal deposits were picturesque. Therefore, metastatic poorly differentiated adenocarcinoma was diagnosed therefore. 
\section[{III. Discussion}]{III. Discussion}\par
The question of the presence of lymph nodes within the breast itself has long been debated \hyperref[b6]{(7,}\hyperref[b7]{8)}. Elsewhere, this was fully traced locally with reference to tuberculous lymphadenopathy within the breast \hyperref[b8]{(9)}.\par
Incidentally, a massive work was presented during the Meeting of the Edinburgh Medico-Chirurgical Society, as far back as 6th January, 1892. It concerned the careful observations made by Harold Stiles \hyperref[b9]{(10)}, assistant to the Professor of Surgery, University of Edinburgh, on the presence of lymph nodes in the breast. Consequently, it is well that modern literature now has this long neglected evidence! \begin{figure}[htbp]
\noindent\textbf{1}\includegraphics[]{image-2.png}
\caption{\label{fig_0}Figure 1 :}\end{figure}
 			\footnote{© 2017 Global Journals Inc. (US)Year 2017} 		 		\backmatter  			  				\begin{bibitemlist}{1}
\bibitem[Onuigbo ()]{b2}\label{b2} 	 		‘Adolescent breast masses in Nigerian Igbos’.  		 			Wib Onuigbo 		.  	 	 		\textit{Am J Surg}  		1979. 137 p. .  	 
\bibitem[Walker ()]{b1}\label{b1} 	 		‘Are all ductal proliferations of the breast premalignant?’.  		 			R A Walker 		.  	 	 		\textit{J Pathol}  		2001. 195 p. .  	 
\bibitem[Stiles ()]{b9}\label{b9} 	 		‘Contribution to the surgical anatomy of the breast and axillary lymphatic glands’.  		 			H J Stiles 		.  	 	 		\textit{Ed in Med J}  		1892. 38 p. .  	 
\bibitem[Onuigbo and Njeze ()]{b8}\label{b8} 	 		‘Intramammary lymph node tuberculosis mimicking cancer’.  		 			Wib Onuigbo 		,  		 			G E Njeze 		.  		 \xref{http://dx.doi.org/10.16966/jto.105}{10.16966/jto.105}.  		 \url{http://dx.doi.org/10.16966/jto.105}  	 	 		\textit{J Infect Pulm Dis}  		2015. 1  (1) .  	 
\bibitem[Egan and Mcsweeny ()]{b6}\label{b6} 	 		‘Intramammary lymph nodes’.  		 			R L Egan 		,  		 			M B Mcsweeny 		.  	 	 		\textit{Cancer}  		1983. 51 p. .  	 
\bibitem[Jadusingh ()]{b7}\label{b7} 	 		‘Intramammary lymph nodes’.  		 			I H Jadusingh 		.  	 	 		\textit{J Clin Pathol}  		1992. 45 p. .  	 
\bibitem[Regitnig et al. ()]{b0}\label{b0} 	 		‘Microsatellite analysis of breast carcinoma and corresponding local recurrences’.  		 			P Regitnig 		,  		 			R Moser 		,  		 			M Thalhammer 		.  	 	 		\textit{J Pathol}  		2002. 198 p. .  	 
\bibitem[Onuigbo ()]{b3}\label{b3} 	 		‘Paget's 1874 article on the breast. Modern misconceptions’.  		 			Wib Onuigbo 		.  	 	 		\textit{Int J Dermatol}  		1985. 24 p. .  	 
\bibitem[Onuigbo ()]{b5}\label{b5} 	 		‘Recurrent carcinoma in mastectomy scars’.  		 			Wib Onuigbo 		.  	 	 		\textit{J Coll Med}  		2004. 9 p. .  	 
\bibitem[Onuigbo ()]{b4}\label{b4} 	 		‘The Paget cell. Mistaken for a parasite a century ago’.  		 			Wib Onuigbo 		.  	 	 		\textit{Am J Dermatopathol}  		1986. 8 p. .  	 
\end{bibitemlist}
 			 		 	 
\end{document}
