Keeping abreast of axillary masses

Abstract

In October, 2010, a previously healthy 48-year-old woman with textured saline breast implants placed subpectorally 8 years ago for aesthetic purposes, presented with 2-month history of a painless mass underneath her left arm. Physical examination showed symmetrical breasts with no overlying skin or nipple changes. There were two large mobile nodes palpable in the left axilla. Initial breast mammography and ultra sonography confi rmed left axillary lymphadenopathy but did not show any periimplant fl uid collection. Biopsy of the left axillary mass showed fi ndings most consistent with classic Hodgkin’s lymphoma, nodular sclerosing type. It lacked two typical stains—CD15 and Pax5. PET-CT showed a 5-cm area of PET-avid left axillary lymphadenopathy. Hodgkin’s lymphoma stage IA was diagnosed. Our patient then had two cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) and 2000 Gy of fi eld radiation to the left axilla. Her initial treatment was completed in March, 2011. Follow-up CT scan in June, 2011, showed a decrease in the size of the left axillary lymphadenopathy. Unilateral fl uid collection, however, was noted around the left breast implant (fi gure). The fl uid increased in size and she presented 6 months later with leakage of serous fl uid from her left breast. Cytology of the peri-implant fl uid showed CD30+ lymphoma cells of indeterminate lineage. Diff erential diagnosis included recurrent Hodgkin’s lymphoma or implant-associated anaplastic large-cell lymphoma. Re peat PET-CT showed PET-avid areas in bilateral axillary lymph nodes. Both implants were removed with capsu lectomies. In October, 2011, she was treated with four cycles of salvage chemotherapy with gemcitabine and cisplatin for assumed recurrent Hodgkin’s lymphoma. Follow-up sonography of the left