Question

Post Modified Radical Mastectomy (MRM) patient presented with upper limb swelling. What is the most probable cause?

• A. Upper limb Lymphedema
• B. Angiosarcoma
• C. Recurrence
• D. Metastasis

Hint:

Think about the most common complication of axillary lymph node dissection during mastectomy.

Answer 1

The Correct Option is A

Step 1: Identify the clinical context. The patient has undergone Modified Radical Mastectomy (MRM), a procedure that involves removal of the breast along with axillary lymph node dissection. Upper limb swelling appearing after this surgery raises the question of the most common complication.

Step 2: Recall post-mastectomy complications causing upper limb swelling. The three major risk factors for post-mastectomy lymphedema are: (i) axillary lymph node removal (disruption of lymphatic drainage), (ii) axillary radiation, and (iii) infection or cellulitis of the upper limb.

Step 3: Analyze each option. Angiosarcoma (Stewart-Treves syndrome) can occur as a late complication of chronic lymphedema but is rare. Recurrence or metastasis can cause lymph node enlargement obstructing lymphatics but is not the most probable acute or common cause. Upper limb lymphedema is the most common cause of arm swelling after MRM, occurring in 2-10% of patients following axillary lymph node dissection.

Conclusion: Upper limb lymphedema is the most probable cause of upper limb swelling following MRM.