A 57-year-old woman, with no medical history of interest, ex-smoker for 15 years, referred from the Breast Cancer Early Detection Unit for a 3.5 cm nodule in the lower left quadrant of the left breast, without palpable axillary lymphadenopathy. The diagnosis was made by biopsy, MRI and axillary ultrasound of infiltrating ductal carcinoma of the left breast with axillary involvement.
Neoadjuvant treatment with standard chemotherapy with FEC 75 (4 cycles) followed by docetaxel (4 cycles). After treatment, there was no radiological response and surgery was performed, with a left mastectomy and Berg level I and II lymphadenectomy.
The definitive anatomopathological diagnosis was infiltrating ductal carcinoma, grade III, 2.6 cm, Her2-neu negative. Oestrogen receptors 98%. Progesterone 38%. P53 29%. Ki 67 35%. Her-2 0%. Keratin 56 positive 1/3. EGFR negative. E-Caderin positive 3/3. Androgen negative. BCL2 positive 2/3. It is a luminal B-Ki67 pattern with metastasis in 1/ 19 lymph nodes.
In the immediate postoperative period there was slight haemorrhage externalised by drainage, and conservative treatment was carried out. On the seventh postoperative day, a debit of 400 ml was observed through the axillary drainage, with a milky appearance, suggestive of chylous lymphorrhoea. The chylous fluid was confirmed by a biochemical study (triglycerides: 800 mg/dl, total cholesterol: 47 mg/dl).
A diet with fat restriction is indicated, advising the ingestion of foods with medium-chain triglycerides and simultaneously administering subcutaneous somatostatin every 8 hours for 10 days. With these measures, the quantity and appearance of the axillary drainage improved and normalised, allowing its removal 20 days postoperatively. No further complications were observed in subsequent check-ups, and the patient went on to complete oncological treatment. The patient is asymptomatic and free of disease after 37 months of follow-up.