title: [A Case of Axillary Arterial Bleeding after Axillary Metastatic Lymph Node Necrosis during Treatment with Paclitaxel and Bevacizumabfor Breast Cancer].
abstract: A 44-year-old woman was diagnosed cT4bcN3cM1(LYM), Stage IV triple-negative breast cancer.Enhanced computed tomography revealed ipsilateral axillary lymph node metastasis, 10 cm in diameter.The supraclavicular and cervical lymph nodes also had metastases.She received paclitaxel(90mg/m2, on days 1, 8, and 15 every 4 weeks)in combination with bevacizumab(10mg/kg, on days 1 and 15 every 28 days).Her height was 165 cm, and her body weight was 100 kg.After 1 course of chemotherapy, a metastatic axillary lymph node with necrotic changes was removed spontaneously.A few days later, she experienced severe bleeding from her axillary artery, and she went into hypovolemic shock.Despite undergoing surgical hemostasis, the bleeding recurred twice, so we performed coil embolization of her subclavian artery.Thirty -five days after the first occurrence of bleeding, the patient died of sepsis and ARDS due to left arm necrosis.Bevacizumab is effective for the treatment of large tumors, but when the tumor is close to an artery, clinicians should be wary of fatal bleeding after necrosis.
authors.affiliation: Dept. of Organ Regulatory Surgery, Fukushima Medical University.
authors.forename: Noriko
authors.initials: N
authors.lastname: Abe
authors.forename: Tohru
authors.initials: T
authors.lastname: Ohtake
authors.forename: Sadahiko
authors.initials: S
authors.lastname: Abe
authors.forename: Keita
authors.initials: K
authors.lastname: Aoto
authors.forename: Maiko
authors.initials: M
authors.lastname: Okano
authors.forename: Kazunoshin
authors.initials: K
authors.lastname: Tachibana
authors.forename: Sayaka
authors.initials: S
authors.lastname: Yoshida
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Yasuda
authors.forename: Izo
authors.initials: I
authors.lastname: Kimijima
authors.forename: Seiich
authors.initials: S
authors.lastname: Takenoshita
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001365:Axilla / Q000098:blood supply / Q000473:pathology*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy*; D017809:Fatal Outcome; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009336:Necrosis / Q000150:complications; D017239:Paclitaxel / Q000008:administration & dosage
chemical_list: D000068258:Bevacizumab; D017239:Paclitaxel