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Applied anatomy, histology, and embryology

Lymphatic drainage and patterns of tumor spread

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SAMPLE QUESTION

A woman develops persistent swelling of her right hand and forearm several months after removal of right axillary lymph nodes for breast carcinoma. The left arm and both legs are unaffected. Duplex ultrasonography shows patent right upper-extremity veins, and her serum albumin concentration is normal. The swollen limb has no erythema or warmth.

Which change most directly accounts for the swelling?