title: Sternal or parasternal involvement from breast cancer: a misleading clinical sign.
abstract: BACKGROUND
  Sternal arch is a nonspecific clinical signs wich may arise during following of breast cancer, this sign reveals an involvement of internal mammary nodes secondary to breast cancer.
  
  
  OBJECTIVE
  To report a rare event such as a loco-regional sternal or parasternal invasion secondary to locally advanced cases of breast cancer (BC) about a Tunisian series.
  
  
  METHODS
  We collected retrospectively from 1988 to 2012, 11 cases of BC treated at the Institut Salah Azaiez (ISA) of Tunis, with presence during the disease evolution (initial or at relapse) of a sternal or parasternal swelling. We analyzed their clinical history, clinical and imaging data (CT-scan and/or MRI), stage, time of occurrence, treatment and evolution
  
  
  RESULTS
  All patients were females and their mean age was 46 years varying from 24 to 75 years. The sternal or parasternal swelling was found at diagnosis in 5 cases and on recurrence in 6 patients after a mean free interval of 24 months, > 12 months in 5 cases. The mean clinical tumor size of the primitive BC was 38 mm (24-75 mm) and lesions located in external quadrants in 3 cases and internal or central in 6 cases. Sternal involvement related to large Intrammmary Chain (IMC) adenopathies was diagnosed by CT-scan. 7 patients had synchronous metastases. 9 out of the 11 patients received a locoregional RT and two received chemotherapy (CT).
  
  
  CONCLUSIONS
  Sternal or parasternal swelling is a clinical apparent symptom of advanced internal mammary lymph nodes in breast cancer. The first etiologic diagnosis in this context is an advanced internal mammary chain (IMC) node involvement from breast cancer.
authors: Radiation therapy department, Salah Azaïz Institute, Tunis Medical School, Tunis El Manar University.
authors: Mongi
authors: M
authors: Maalej
authors: Dalenda
authors: D
authors: Hentati
authors: Mehdi
authors: M
authors: Afrit
authors: Hanen
authors: H
authors: Boudabous
authors: Chiraz
authors: C
authors: Nasr
authors: Khalil
authors: K
authors: Mahjoubi
authors: Walid
authors: W
authors: Gargouri
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D013249:Sternum; D055815:Young Adult