Female, 44 years old, with history of recurrent triple negative breast cancer with right pectoralis muscle tumor causing paresthesias and weakness of the right arm. Evaluate for extent of tumor involvement in the plexus and nearby supraclavicular and axillary disease. After radiation treatment and Xeloda. For potential surgery planning. The large centrally necrotic tumor aggregate in the right subpectoral axilla is stable to slightly reduced in size since the previous examination. In the axial plane, it measures 9.2 cm x 7.5 cm compared to 11.1 cm x 9.0 cm previously. The lesion, however, is more necrotic than previously with less solid, peripheral tissue. Relationship to adjacent structures has not significantly changed. The mass is still contiguous with the chest wall and extends laterally almost to the humeral cortex but with no evidence of osseous invasion. Superiorly, it extends just above the clavicle, and inferiorly it indents the breast implant.The much smaller discontiguous tumor deposits are evident within the right supraclavicular fossa and lower neck and not significantly changed.The above lesion resides predominantly at the level of the cords and terminal branches of the right brachial plexus. The plexus is difficult to track with certainty, but the neurovascular structures can in general be followed as they are displaced posteriorly by the mass. No clear evidence of neurovascular encasement is seen. Numerous lung nodules and perihilar adenopathy are also present.
The bulky necrotic right axillary mass is stable to slightly reduced in size but shows decreasing solid enhancement and increasing necrosis which may reflect response to treatment. The components of the brachial plexus remain visible as they're displaced along the posterior margin of the lesion. As before, no definite evidence of neurovascular encasement is seen.