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| Journal of the New Zealand Medical Association,
11-May-2012, Vol 125 No 1354
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Brenda Leal, Sabas Vieira, Bárbara Carvalho, Airthon
Correia, Benedito Almeida
In 1939, the French surgeon Henri
Mondor1 described a rare, self-limited
condition of benign nature characterised by thrombophlebitis of superficial
veins of the breast, more commonly the thoracoepigastric vein and its
branches.2 The clinical hallmark is a fibrous
cord, occasionally with the aspect of rosary beads, that can be asymptomatic or
cause pain.
Its aetiology is multifaceted and there are reports in the
literature of an association between Mondor’s disease and breast cancer.
This disease occurs more commonly in women than men, mainly in the third and
fourth decades of life,3 leading to a
spontaneous remission in most cases.
We report a case of a patient that had been treated for
breast carcinoma in situ.
Case reportA 45-year-old female patient with a history
of carcinoma in situ on the left breast had undergone segmental
resection of the left breast with intraoperative frozen-section evaluation of
the margins 9 months prior to developing Mondor’s disease. The frozen and
paraffin sections demonstrated tumor-free surgical margins. The patient received
postoperative adjuvant radiation therapy and progressed with mild actinic
dermatitis, which then resolved completely. She had been taking tamoxifen 20
mg/day for 8 months without significant side effects, except for hot flushes.
Three days earlier the patient experienced severe pain
accompanied by a painful cord-like hardening on the left chest wall and a
“pulling” sensation. On the physical examination, her breasts and
axillae were normal and a proper healing of the left breast surgical scar was
noted. There was no evidence of ongoing oncologic disease. The patient had a
fibrous cord and a thickening of approximately 20 cm located on the topography
of the left lateral thoracic vein (Figure 1) consistent with thrombophlebitis of
the left lateral thoracic vein (Mondor’s disease).
Breast mammography and ultrasound had been performed 4
months earlier and were unremarkable.
Non-steroidal anti-inflammatory drugs were prescribed and
the condition subsequently resolved. Four months after the diagnosis, the
patient remains asymptomatic.
Figure 1. Fibrous cord with about 20cm in the
topography of the lateral thoracic left vein
 DiscussionMondor’s disease is a thrombophlebitis that affects
mainly the superficial veins of the breast. The blood vessels most involved are
the lateral thoracic, the thoracoepigastric and the superior epigastric
veins.4 Rarely, it affects areas such as the
penis, groin, abdomen and upper limbs.2
The disease affects more women than men, at a 3:1
ratio.3 About half of the cases have an
idiopathic origin. Among other causes are hypercoagulable states, thoracic
surgical traumas (mainly after breast biopsy or removal of this gland), wearing
of tight clothes, breast infection and inflammation, physical exertion, and
breast carcinoma (which account for up to 12% of
cases).5–7
This condition is related to the compression of superficial
vessels of the breast by tumors or metastases, leading to a blood
stasis.8 To date, we have not found any report
in the literature of the occurrence of a similar case after treatment of breast
carcinoma in situ and no other factor has been identified as associated
with Mondor’s disease in this case.
The major symptoms are pain, breast enlargement and skin
tethering on the site of the thrombosed vessel. On the physical examination, the
primary hallmark is a fibrous cord or a palpable mass. There are also
asymptomatic cases.9 The diagnosis is
essentially clinical and the treatment is based on anti-inflammatory and
analgesic drugs.10 The patient of the present
case progressed to complete resolution of symptoms, after treatment.
Patients with a previous diagnosis of breast cancer, or any
alteration of the breast, leads to stress, as they usually relate these
alterations to a recurrence of the disease. Therefore, a comprehensive
understanding of the disease is essential in an attempt to reduce the
patient’s stress and prevent unwarranted procedures.
Author information: Brenda Barros Leal,
Medical Student; Sabas Carlos Vieira, Adjunct Professor of the Department of
Internal Medicine; Bárbara Virgínia F. de Carvalho, Medical
Student; Airthon Carlos Correia, Medical Student; Benedito de S. Almeida,
Medical Student; Federal University of Piaui, Teresina (PI), Brazil
Acknowledgement: We thank the patient for
her consent and cooperation.
Correspondence: Brenda Leal, FAMEPI, UFPI,
Frei Serafim Av., 2280 – Centro – Postcode 64001-020/Teresina-PI,
Brazil. Email: brenda.leal13@hotmail.com
References:
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