Axillary Lymph Node Swelling Research Articles

Abstract P1-12-04: Side Effects of the mRNA COVID-19 Vaccines in Women Treated for Breast Cancer

Abstract Background: The introduction of the novel COVID-19 vaccination raised concerns regarding side effects from patients who had undergone breast cancer treatment. Lymph node swelling after the mRNA vaccines (Moderna, Pfizer) is a distressing side effect for women treated for breast cancer as it may indicate cancer progression or recurrence. Patients at risk of breast cancer-related lymphedema (BCRL) are fearful that lymph node swelling from the vaccine could incite or worsen BCRL. Data investigating associated side effects in this population is essential for patient education and future self-advocacy. Purpose: The purpose of this study was to elicit side effects associated with the COVID vaccine in women treated for breast cancer. Methods: 4,945 surveys were sent to women over the age of 18 who had received breast cancer treatment and had been prospectively screened for BCRL with perometry. 621 participants who received an mRNA vaccine and responded to the survey were included in analysis, 469 of whom completed booster dose surveys. Participants were asked about type and duration of side effects after each vaccine dose. Solicited side effects included injection site soreness, swelling, or redness; swelling, numbness, or heaviness of the arm; generalized muscle soreness (GMS); fatigue; headache; joint pain; chills; nausea; vomiting; fever; Bell’s palsy; axillary or supraclavicular lymph node swelling; other; or none of the above. We computed frequencies and the median duration of side effects for each dose. To investigate predictors of side effects, we fit multivariable logistic regression models separately for each side effect, with random effects for participants to account for clustered responses. We considered significant predictors those with p < 0.05. Results: Of the 621 participants, the median follow-up time between breast surgery and date of first vaccine dose was 69 months. The distribution of the top 5 side effects is presented in Table 1. Of note, the majority of participants who reported lymph node swelling (9.8% dose 1, 12.9% dose 2, 11.3% dose 3) reported it in the axilla ipsilateral to the vaccine (54.1% D1, 61.3% D2, 71.7% D3). Lymph node swelling was also reported in the axilla contralateral to the vaccine (45.9% D1, 45% D2, 24.5% D3), supraclavicular region ipsilateral (29.5% D1, 26.3% D2, 32.1% D3) and contralateral (18% D1, 18.8% D2, 9.4% D3) to the vaccine. Older patients reported each side effect significantly less frequently. Those who had received neoadjuvant chemotherapy reported significantly more GMS and headache than those who did not. Those who had received regional lymph node radiation were less likely to report GMS, as were patients who had sentinel lymph node biopsies (vs. no lymph node surgery). The median duration of side effects for all three doses was 48 hours or less, with the plurality (41.0% D1, 38.7% D2, 44.1% D3) of participants reporting side effects lasting 24 hours or less. While all side effects apart from injection site soreness were significantly more common in the second than the first doses, the duration of side effects only increased for 28.1% of participants. Conclusion: Over 86% of women treated for breast cancer may experience at least one side effect after any dose of the COVID-19 vaccine. This data, collected specifically for patients with breast cancer, will help enhance guidelines for structured and universal education regarding additional doses of the vaccine in the future. This will allow patients to better understand COVID vaccine side effect profiles after breast cancer treatment and self-advocate prior to future doses. Table 1. Top 5 Side Effects Reported Citation Format: Brooke Juhel, Cheryl L. Brunelle, Madison C. Bernstein, Louisa H. Smith, Amanda W. Jung, Elizabeth K. Hausman, Loryn K. Bucci, George E. Naoum, Alphonse G. Taghian. Side Effects of the mRNA COVID-19 Vaccines in Women Treated for Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-12-04.

The Effect of Early Movements of Swollen Lymph Nodes Caused by COVID-19/ Vaccine of COVID-19 on Recovery

Background: The swelling of the lymph nodes may raise some concerns and anxiety for people after getting the vaccination, especially for COVID-19. Many women seek medical attention for the enlarged lymph node due to the known relationship between lymph nodes and breast cancer. This research is intended to enrich the data of the most recent COVID-19 pandemic and the vaccines that were developed shortly after. The aim is to see if there is an effect of early movement of the swollen axillary lymph nodes caused by the COVID-19 vaccination and to enrich the data of the most recent COVID-19 pandemic and its developed vaccines shortly after.
 Methods: A voluntary survey was used to collect data from recently vaccinated individuals. Data were analyzed for associations between early movement and resolution of lymphadenopathy.
 Results: 32 (20.38%) of 157 participants reported swelling of axillary lymph nodes that resulted from COVID-19 vaccination. Duration of swelling ranged from 1 to more than two weeks. The early movement did not show a statistically significant reduction in the course of swelling.
 Conclusion: Early movement of areas affected with lymph node enlargement, whether active or passive, does not seem to cause additional side effects. The effect of early action seems comparable to rest (see Fig.), although it may lessen erythema due to improved circulation, just like the newer concept of early movement after a skeletal injury has a better outcome than merely resting, which was the older method of recovery. However, the current data is limited to support the benefit of such a concept.

A rare case of hepatosplenic cat scratch disease

A female patient in her 60s, treated with oral corticosteroids for scleroderma diagnosed 11 years ago, visited our hospital complaining of a persistent fever and liver dysfunction. She was treated with antibiotics, but her fever continued. Abdominal ultrasonography revealed multiple hypoechoic splenic masses. Splenic masses revealed multiple masses with no contrast effect in arterial and portal phases and nuclear in equilibrium phase by contrast computed tomography study, as well as hyperintensity masses with low signal areas in magnetic resonance imaging T2-weighted images. Liver tissue was obtained by percutaneous liver biopsy, and histological findings showed epithelioid cell granulomas without tumor cells. Further interview and physical examination revealed scratch scars from domestic cats and left axillary lymph node swelling. Hence, a cat scratch disease was suspected. She was diagnosed with cat scratch disease by serum indirect immunofluorescence. Her fever was resolved with minocycline administration. Therefore, persistent fever with splenic masses should be suspected of hepatosplenic cat scratch disease.

Venous Thoracic Outlet Syndrome Combined with Brachial Neuritis Caused by Lymphadenopathy after Vaccination for Coronavirus Disease 2019: A Case Report

Thoracic outlet syndrome (TOS) occurs due to compression of the neurovascular bundle exiting the thoracic outlet, through which the brachial plexus and subclavian vessels pass. Here, we report a case of venous TOS combined with brachial neuritis, which was caused by axillary lymphadenopathy after the first dose of the BNT162b2 vaccine against coronavirus disease 2019 (COVID-19). A 17-year-old female patient presented with left upper extremity swelling and pain after inoculation with the BNT162b2 vaccine in the left deltoid muscle. Contrast-enhanced brachial plexus magnetic resonance imaging revealed severe swelling of the left axillary and subclavian lymph nodes, which lie immediately above the subclavian vein. An electrodiagnostic study revealed left brachial plexopathy, mainly involving the lower trunk with mixed demyelinating and axonal injury. The patient received intravenous steroid pulse therapy and oral steroid therapy. A follow-up examination showed complete recovery of muscle strength and function, pain, and swelling in the left upper extremity within 3 months after vaccination against COVID-19.

Breast neuroendocrine tumor arising in the axilla of a man: a case report

BackgroundAccessory breast carcinomas of the axilla of males are rare, and primary breast neuroendocrine tumors (BNETs) are rare as well. We present a case of a BNET arising in the axilla of a man.Case presentationA 64-year-old Japanese man presented with a hard 15-mm mass in the axilla and axillary lymph node swelling. Histopathological examination of the incisional biopsy specimen revealed a neuroendocrine carcinoma. Therefore, wide radical excision of the axillary tumor and axillary lymph node dissection were performed. Hematoxylin and eosin staining showed that the solid tumor was mainly located in the subcutaneous adipose tissues and appeared to invade the skin. The tumor phenotypes were positive for CAM 5.2, synaptophysin, estrogen receptor, progesterone receptor, and GATA-binding protein 3; they were negative for human epidermal growth receptor 2. The neuroendocrine component comprised more than 90% of the tumor, and the Ki-67 index was 21%. These results indicated that the tumor was a BNET. This patient underwent adjuvant chemotherapy, endocrine therapy, and radiotherapy.ConclusionsBNET cases in males are rare. The clinical and histological criteria as well as treatment for these rare cases are discussed.

The Adverse Reactions of Pfizer BioNTech COVID-19 Vaccine Booster Dose are Mild and Similar to the Second Dose Responses: A Retrospective Cross-Sectional Study.

BackgroundLike other vaccines, Pfizer BioNTech’s COVID-19 vaccine efficacy against SARS-CoV-2 virus infections begins to decline within a few months after the 2nd dose. On August 12, 2021, the FDA allowed additional Pfizer BioNTch’s COVID-19 vaccine dose (3rd or booster dose) for individuals with weakened immunity. This study aimed to evaluate the short-term adverse reactions (ADRs) of the 2nd and the 3rd doses of the Pfizer BioNTech COVID-19 vaccine.MethodsInformation for this study was collected by Google Form questionnaire (online survey). The results included responses from 442 people, the majority from Saudi Arabia.ResultsThe most common local ADRs following the 3rd dose were injection site pain, injection site hypersensitivity, and axillary lymph node swelling. The most common systemic ADRs were fatigue, muscle pain, bone pain, headache, and fever less than 38ºC. Less common systemic ADRs were shivering, fever more than 38ºC, nasal congestion and rhinorrhea, arrhythmia, cough, abdominal pain, chest tightness, nausea, diarrhea, vomiting, and tachypnea. Rare systemic ADRs were constipation, dizziness and vertigo, lack of concentration, sore throat, excessive hair loss, dysmenorrhea and heavy menstruation, and Bell’s palsy. Severe allergic reactions were reported by 2.6% of participants after the 2nd dose, compared with none after the 3rd dose. Nasal congestion and runny nose are more frequent after the 3rd dose. The ADRs of the 2nd and 3rd doses were significantly more prevalent in females. 12% of participants reported ADRs lasting more than one week after the 3rd dose compared to 5% after the 2nd dose. People ≤ 60 years were more affected by the vaccine ADRs.ConclusionMost of the ADRs reported after the 3rd vaccine dose were consistent with the Pfizer vaccine information sheet and similar to the 2nd dose ADRs.

Freeze-dried live attenuated smallpox vaccine prepared in cell culture “LC16-KAKETSUKEN”: Post-marketing surveillance study on safety and efficacy compliant with Good Clinical Practice

BackgroundIn Japan, production of smallpox vaccine LC16m8 (named LC16-KAKETSUKEN) was restarted and was determined to be maintained as a national stockpile in March 2002. ObjectiveTo conduct a post-marketing surveillance study of the vaccination of freeze-dried live attenuated smallpox vaccine prepared in cell culture LC16-KAKETSUKEN using attenuated vaccinia strain LC16m8. The study complied with Good Clinical Practice, focusing on a comparison between primary vaccinees and re-vaccinees. Method268 personnel (261 males and 7 females) of the Japan Ground Self-Defense Force were inoculated with LC16-KAKETSUKEN and thereafter adverse events and efficacy were evaluated. ResultsAmong 268 vaccinee participants, the following vaccinees showed adverse events, none serious: 53 of 196 primary vaccinees (without previous smallpox vaccination), 4 of 71 re-vaccinees (with previous smallpox vaccination) and 1 vaccinee with unknown previous vaccination history. A breakdown of adverse events observed in this study (total 268 vaccinees) showed the following minor or mild adverse events: 52 (19.4%) swelling of axillary lymph node, 4 (1.5%) fever, 2 (0.7%) fatigue, 1 (0.4%) of rash, 14 (5.2%) erythema at the inoculation site, 1 (0.4%) swelling at the inoculation site and 1 (0.4%) autoinoculation. The incidence of adverse events for primary vaccinees (53/196; 27.0%) was significantly higher than for re-vaccinees (4/71; 5.6%). However, the proportion of vaccine take was significantly higher for primary vaccinees (185/196; 94.4%) than for re-vaccinees (58/71; 81.7%). Although the proportion of vaccine take of re-vaccinees was significantly lower than for primary vaccinees due to preexisting immunity by previous vaccination, no significant difference was found in neutralizing antibody titers between primary vaccinees and re-vaccinees at 1, 4 and 7 months after LC16-KAKETSUKEN vaccination. ConclusionThe present post-marketing surveillance study compliant with Good Clinical Practice demonstrated the efficacy and safety of the smallpox vaccine LC16-KAKETSUKEN in an adult population. LC16-KAKETSUKEN is the sole currently available licensed smallpox vaccine for both adult and pediatric populations.

Primary peritoneal serous papillary carcinoma that metastasized to an axillary lymph node in a woman with a history of breast cancer: A case report and diagnostic pitfalls

Herein, we will report on a patient with primary peritoneal serous papillary carcinoma that metastasized to an axillary lymph node and who had previously undergone a mastectomy and chemotherapy for carcinoma of the right breast. A 40-year-old Japanese woman underwent partial resection of her left lung for metastatic breast cancer at our hospital. Thirteen years later, she developed a left axillary lymph node swelling, and a biopsy was performed. Histological findings were compatible with metastatic breast carcinoma. Positron emission tomography–computed tomography revealed systemic lymphadenopathy, peritoneal nodules, and a liver mass. The patient was diagnosed with recurrent breast cancer and underwent additional chemotherapy. Six months later, she developed ascites. She was diagnosed with serous adenocarcinoma using conventional and immunocytological examinations of the ascites. She underwent suboptimal debulking surgery, consisting of a total hysterectomy, bilateral oophorectomy, and partial omentectomy. The final pathological diagnosis was primary peritoneal serous papillary carcinoma.The diagnosis and pitfalls of this case will be presented.

Diagnosis of ruptured breast implants through high-resolution ultrasound combined with real-time elastography.

Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Sonoelastography is a new ultrasound-based technique that allows assessment of tissue elasticity. This study was undertaken to evaluate elastographic findings in normal and ruptured breast implants. This prospective study included 28 implants in 16 patients, all of whom underwent high-resolution ultrasound and real-time elastography. The diagnosis of implant rupture was confirmed by surgery. Implant rupture was diagnosed in 5 out of 28 implants (17.9%). In those patients with ruptured implants, 3 had no symptoms, 1 presented with pain, and 1 complained of ipsilateral axillary lymph node swelling. Implants with a homogenous anechoic interior were considered to be intact. Ultrasound findings indicating implant rupture included multiple parallel echogenic lines in the implant interior in 2 cases and a mix of hyperechoic and hypoechoic masses in 3 cases. The feasibility of real-time elastography of implants was demonstrated in all cases. Elastograms of intact implants revealed a typical blue-green-red pattern familiar from cystic lesions. In all 5 ruptured implants, elastography revealed yellow-green figures without typical layering. To the authors' knowledge this is the first series to combine high-resolution ultrasound with real-time elastography for the diagnosis of implant rupture. Since there are distinct differences between elastograms of intact and ruptured implants, addition of real-time elastography to conventional ultrasound may improve implant surveillance and obviate the need for magnetic resonance imaging.

Inappetenz, Nachtschweiß, chronisches Ekzem und inguinale sowie axilläre Lymphknotenpakete bei einem 28-jährigen Patienten

A 28-year-old man presented with loss of appetite, night sweats, eczema, and axillary and inguinal lymph node swelling. The tentative diagnosis of malignant lymphoma was made. To confirm the diagnosis, extirpation of a lymph node and a skin biopsy were performed. Systemic treatment with methylprednisolone resulted in an improvement of eczema and lymph node swelling. Because of the histological findings and clinical course, we diagnosed dermatopathic lymphadenopathy, also known as Pautrier-Woringer syndrome.

Triphasic differentiations of Merkel cell carcinoma in primary and metastatic lesions

We present a rare case of Merkel cell carcinoma (MCC) with heterologous differentiation. The patient was an 86-year-old female patient with MCC who presented with a forearm skin tumor and left axillary lymph node swelling. Histopathologically, the malignant components of the primary and metastatic lesions showed the intermingled features of triphasic phenotype differentiation, which had distinct cell populations; MCC, sweat gland carcinoma (SGC) and malignant poorly differentiated spindle cells with myogenic differentiation were immunohistochemically showed. Moreover, an electron microscopic observation of the tumor cells revealed intracytoplasmic canaliculi and junctional structures that indicated ductal differentiation. To our knowledge, this is the first case of MCC admixed with SGC and sarcomatous components in both the primary and metastatic lesions. An immunohistochemical study, using several stem cell markers, indicated that the MCC arose from pluripotent epidermal stem cells.

著明な貧血と血小板減少と末梢血の異常細胞で発見された転移性乳癌の１例

Worldwide, breast cancer accounts for 22.9% of all cancers excluding non-melanoma skin cancers in women. More than 80% of breast cancer cases are discovered when a woman discovers a lump that feels different from the rest of the breast tissue. We report the case of a 60-year-old woman who had been treated for one year at a psychiatric hospital for suspected schizophrenia, and was referred to our hospital on March 23, 2011 for consultation regarding complete blood count abnormalities: hemoglobin, 4.8g/dl ; Plt, 1.9×104/μl ; WBC, 12,700/μl with 18.5% abnormal cells. Computed tomography revealed an enhanced, irregular mass in her right breast as well as right axillary lymph node swelling, suggestive of breast cancer. BM biopsy confirmed the presence of abnormal, keratin-positive cells, suggesting metastasis to the bone. CA15-3 was 300U/ml (normal range ＜25). The patient died on April 11, 2011, post-admission day 20. We found a rare case of terminal breast cancer that presented with peripheral blood abnormality. Breast cancer in patients who do not notice breast abnormality can present with peripheral blood abnormality.

IL-6-positive classical Hodgkin’s lymphoma co-occurring with plasma cell type of Castleman’s disease: report of a case

We present a case of classical Hodgkin's lymphoma (HL) co-occurring with histological features of Castleman's disease (CD). A 25-year-old man presented with left supraclavicular and axillary lymph node swelling and mediastinal mass. Using an initial biopsy specimen from left axillary lymph node, a tentative diagnosis of multicentric CD of plasma cell type was made. The serum level of interleukin-6 (IL-6) was elevated. The patient was treated with immunosuppressive therapy containing tocilizumab (TCZ). Shrinkage of mediastinal mass and axillary lymph nodes was seen; however, swelling of his left axillary lymph nodes reemerged, even after therapy with TCZ. A second left axillary lymph node biopsy was performed and a diagnosis of nodular sclerosis of classical HL without histologic features of CD was made. The initial biopsy specimen was re-examined, and scattered CD30+ Hodgkin/Reed-Sternberg cells were found in the interfollicular area. Interestingly, Hodgkin/Reed-Sternberg cells and surrounding reactive cells in both lymph nodes were stained with anti-IL-6 antibody. We emphasize that biopsy specimens with HL involvement may also have histologic features reminiscent of those seen in CD. To our knowledge, this is the first report to provide a detailed description of this pathology, including a survey of IL-6 and clinical course upon treatment with TCZ.

The Effectiveness of Combined Medical Therapy and Hemodialysis for Hypercalcemia in Anaplastic Lymphoma Kinase-negative Anaplastic Large Cell Lymphoma

A 71-year-old man with a right lower abdominal quadrant epithelial tumor developed gradually worsening lumbago and dysbasia. He became comatose and was admitted to our hospital. He had swelling of the left axillary lymph nodes and necrosis of the 4.0-cm diameter abdominal tumor, which infiltrated the subcutaneous tissues. He was hypercalcemic (16.7 mg / dl) , and had elevated levels of soluble interleukin-2 receptor (24,090 U / ml) and parathyroid hormone- related protein (5.4 pmol / l) . Computerized tomography (CT) showed left axillary lymphadenopathy, splenomegaly, and a right abdominal-wall mass that was described as anaplastic large cell lymphoma upon pathology. Brain radiography and CT revealed multiple lesions infiltrating the cranium. Magnetic resonance imaging showed diffuse low signal intensity throughout the vertebral spine. The patient was diagnosed with anaplastic lymphoma kinase (ALK) -negative anaplastic large cell lymphoma with hypercalcemia. Fluid replacement and drug therapies including calcitonin had no effect on the hypercalcemia or the coma. The patients serum calcium concentration decreased after hemodialysis (calcium dialysate concentra- tion, 5 mg / dl) and subsequent zoledronic acid hydrate therapy. His consciousness improved by thefth day of treatment. This rare case of hypercalcemia in ALK- negative anaplastic large cell lymphoma improved with combined medical and hemodialysis therapy.

Tuberculous Cold Abscess in the Axillary Lymph Nodes

A 56-year-old woman was admitted to the regional medical center suffering from dyspnea.She was diagnosed with tuberculous pericarditis and was treated with antituberculous drugs(INH,RFP, EB,and PZA).One month later,her cardiac condition was ameliorated and she was discharged.Subsequently EB and PZA were stopped.Two months later,she started to suffer from painful swelling of the left axillary lymph nodes.Although her cardiac condition was stable, the size of the lymph nodes was gradually enlarged (Fig. 1 A). CT and FDGPET showed a few translucent lymph nodes (Fig.2 A) and there was no sign of other malignancy. Because the swelling of the lymph nodes progressed in spite of the amelioration of pericarditis, the etiology was assumed to be neoplastic or autoimmune in nature.She was therefore referred to our hospital.On admission,she was afebrile and had no symptoms except for the swelling of a left axillary lymph node, which was approximately 4 cm in diameter,elastic and partially reddish.Blood examination revealed a slight inflammatory reaction (CRP 0.14 mg/dl, ESR 13 mm/hr). Contrast enhanced CT showed a consistent low density area surrounded by a ring-enhancing lesion (Fig.2 B).The tumor’s elasticity and CT findings suggested that the swelling was an abscess and EB was resumed. The abscess was located next to the skin and was on the verge of collapse.In case of collapse, there was the risk of nosocomial transmission, so we selected needle aspiration.Aspirated fluid revealed yellow pus (Fig. 3 A) which contained acid-fast bacteria (Fig. 3 B), though the subsequent culture revealed no growth of those.A diagnosis of tuberculous cold abscess was made.Two weeks after the aspiration,the abscess swelled and collapsed.It was surgically resected and she received an additional antituberculous medication(SM)because the lesions seemed to extend into neighboring lymph nodes in spite of medication with INH,RFP and EB.Three months after the surgical procedure, the abscess swelled again and broke forming a fistula(Fig.1 B), with the histology typical of a granuloma(Fig.3 C). With daily lavage through the fistula and continuous use of antituberculous drugs,her tuberculous lymph node lesions were completely cured 6 months after the last collapse.Although the lymph nodes are the most common sites of extrapulmonary tuberculosis ,tuberculous cold abscess in lymph nodes is less frequent in Japan .This case suggests that tuberculous lymphadenitis is an important differential diagnosis in examining lymph node swelling and that its progression is not always parallel to the exacerbation of other tuberculous disease conditions.

Rapidly progressive descending aortic pseudoaneurysm resulting from primary malignant fibrous histiocytoma

A 66-year-old man with a history of asymptomatic bilateral swelling of the axillary lymph nodes was admitted with hoarseness and pain of the right knee. Computed tomography showed a large pseudoaneurysm deriving from descending aorta. We planned to resect the pseudoaneurysm, and repair the aortic wall. Resection of the pseudoaneurysm and patch-closure of the defect of the aorta were performed successfully. Pathological examination of the pseudoaneurysm revealed malignant fibrous histiocytoma. The clinical course was very miserable. Intrathoracic recurrence occurred 7months after surgery, and he died of multiple brain metastases 10months postoperatively.

Hidradenitis suppurativa in a HIV-infected child

Hidradenitis suppurativa (HS), a painful and chronic condition, commonly occurs in women and coincides with post-pubertal increase in sex hormones. A 13-year-old pre-pubertal HIV-infected male child presented to our clinic with a discharging right axillary lymph node swelling. The biopsy of the lesion showed features of HS. The patient was treated with oral antibiotics, oral steroids, and local antibiotic wash. Though the patient responded to this treatment, the clinical response was not adequate and the lesion recurred. Subsequently, the child was started on antiretroviral therapy (zidovudine, lamivudine, and nevirapine). Following these medications, the lesions healed and had not recurred till we last examined the child. Thus, this is a rare presentation of a known condition in an HIV-infected pre-pubertal male child, which did not respond to usual modalities of treatment and had to be treated with antiretroviral therapy.

Marked response to imatinib mesylate in metastatic acral lentiginous melanoma on the thumb

We report a case of melanoma that had a marked response to treatment with imatinib mesylate (IM). The patient was a 61-year-old man who presented with a small red nodule on the thumb and destruction of the nail plate. On histological examination, this lesion was diagnosed as a melanoma, and computed tomography revealed lymph-node swelling in the left axilla and nodules in both lung fields. Although the patient received intratumoral injections of interferon-β and systemic administration of dacarbazine, both primary and metastatic lesions increased in size. Immunochemistry detected a KIT mutation, which was confirmed by DNA sequencing analysis, and patient was given IM. Within 2 weeks of starting the IM regimen, the size of the nodule on the nail plate markedly decreased, and the axillary lymph-node swelling and lung-nodule formation regressed. This case suggests that IM may be a promising treatment option for KIT mutation-positive melanoma.

Breast cancer with cartilaginous and/or osseous metaplasia diagnosed by lymph nodal metastasis: a case report.

Breast cancer with cartilaginous and/or osseous metaplasia is a type of metaplastic carcinomas and is a rare disease. We report the case of a 49 year-old female who underwent right mastectomy for a large breast tumor. Histological examinations revealed a mixed tumor with both stromal and epithelial elements;the stroma showed poor differentiated spindle-shape and multiform cells with a massive osseous matrix, and atypical epithelial cells, which mainly existed on the surface of the cysts, showed nucleic atypia. The tumor was diagnosed as a malignant phyllodes tumor with osteosarcomatous differentiation;it was not identified as a metaplastic carcinoma because of the lack of proof of a cancerous component. Two years after a mastectomy, swelling of the axillary lymph nodes was found and a biopsy was performed. Histological findings for the lymph node indicated a metastasis of the invasive ductal carcinoma. The primary tumor was re-examined and was considered to be the origin of the lymph nodal metastasis. Lymph nodal metastasis of cancer proved that the primary tumor had cancerous potential, and the pathological diagnosis was altered to a breast cancer with cartilaginous and/or osseous metaplasia.

Breast tuberculosis: A case report

Primary tuberculosis of the breast unlike carcinoma is rare, but secondary lesions from cervical and axillary tuberculous lymphadenitis are not uncommon. In this case, a 60-year-old woman presented with ulcerated axillary lymph node swelling and breast lump. Biopsy of the breast lump and lymph node confirmed tuberculous granuloma. She was commenced on anti-tuberculous chemotherapy and wound dressing. Her wounds and sinuses healed satisfactorily before being discharged to continue her treatment at home. She was however lost to followup.