Axillary lymph node tuberculosis presenting lymphographic signs of metastasis from ipsilateral breast cancer.

Abstract

Only A Few Cases have been reported of lymphography in lymph node tuberculosis. The purpose of this report is to present a case of ipsilateral axillary node tuberculosis and breast cancer and to discuss the difficulties of lymphographic differentiation of metastasis and tuberculosis. In a review of the records of our Department of Pathology, we found that out of 1,106 patients with breast cancer there were 5 with additional and histologic proof of axillary lymph node tuberculosis on the same side (0.45 per cent). Case Report E. A., a 46-year-old female, had been treated for cerebrovascular disease in the Department of Neurology and Psychiatry since 1966. At the age of seventeen years a puerperal mastitis of the left breast had necessitated surgery. Because of scar retraction she was admitted to the Department of Surgery in 1968. The cicatrix was in the middle of the outer two quadrants and was combined with a palpable tumor the size of a cherry (Fig. 1). In addition, enlarged lymph nodes were palpable in the left axilla. A chest film showed an old apical tuberculous infection of the left superior lobe. Left axillary lymphography was carried out on Sept. 27, 1968. Three and five-tenths milliliters of Lipiodol Ultrafluid was instilled into the dorsum of the hand at the rate of 1ml in twelve minutes. The lymphogram at the conclusion of injection showed large central filling defects (Fig. 2). The marginal sinuses of nearly all the nodes were outlined. At twenty-four hours the filling defects were even clearer (Fig. 3), and we believed them to represent metastases. Ten days later an en bloc resection of the left breast and the axillary tissue was performed. Histological examination disclosed tuberculosis with no sign of metastatic involvement of the left axillary nodes (Fig. 4). Discussion The reported lymphographic findings of lymph node tuberculosis are summarized in TABLE I. In addition, Bussat et al. (4) performed lymphography in a patient with nonreactive tuberculosis (typho-bacillosis Landouzy). Both the lymphograms and the roentgenograms of the postmortem retroperitoneal specimen showed findings similar to those of Hodgkin's disease in the fibrotic stage. The authors agree with others (2–5, 7) on the difficulty of lympho-graphic differentiation between metastatic and tuberculous involvement of the lymph nodes. The complete outlining of the marginal sinuses in several nodes on the lymphogram should, however, alert the physician to look for other clinical and roentgen signs of tuberculosis which could confirm a diagnosis of lymph node tuberculosis. Summary A case is presented of ipsilateral breast cancer and tuberculous axillary nodes. In the belief that the lymphographic findings indicated metastasis to the lymph nodes, surgery was performed, and histologic examination showed no evidence of metastasis.