Axillary Mass Research Articles

Keeping abreast of axillary masses

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

Case 1: Axillary mass in a First Nations infant

Case 1: Axillary mass in a First Nations infant

Toxoplasmic Lymphadenopathy Presenting as a Palpable Axillary Mass - A Case Report

Usually infection with Toxoplasma gondii is asymptomatic and no treatment is required. Less than 10% of the cases present with clinical symptoms such as lymphadenopathy in the head and neck region, asthenia, fever, cephalea and arthralgia. This case report illustrates an unusual case of Toxoplasmosis presenting as a palpable axillary mass in an otherwise healthy individual. J Med Cases. 2012;3(5):283-285 doi: https://doi.org/10.4021/jmc692w

Pure Apocrine Nevus

Apocrine nevus is a rare tumor composed of increased mature apocrine glands and ductal structures within a fibrous stroma, located predominantly in the reticular dermis. They have been reported in association with apocrine carcinoma, extramammary Paget disease, and syringocystadenoma papilliferum; less commonly a pure apocrine nevus is identified, unassociated with another apocrine proliferation. Clinically apocrine nevi may appear as solitary or multiple nodules or plaques on the scalp, presternal skin, though they are seen most commonly in the axillae. We describe 4 cases of pure apocrine nevus, all of which appeared clinically as painless or mildly tender skin-colored axillary masses, 2 of which were bilateral. In each case, the lesions appeared in adulthood, and patients denied knowledge of congenital or childhood presence. Patients denied pruritis, discharge, bleeding, or antecedent trauma. Grossly, the specimens consisted of subcutaneous, multicystic ill-defined nodules. Biopsy showed prominent apocrine glands composed of irregularly columnar luminal cells with eosinophilic cytoplasm arranged in a somewhat organoid pattern filling the reticular dermis and extending into the subcutaneous adipose tissue. The glandular luminal cells displayed decapitation secretion. There was a paucity of pilosebaceous units. In one case, the overlying epidermis was papillomatous. The deepest portion of one specimen had lactational change simulating a lactational adenoma. No atypia was seen in either the glandular structures or the stroma. The adjacent sebaceous and eccrine structures were normal. The histologic features and immunohistochemical profile in relation to other apocrine lesions will be reviewed.

A Rapidly Enlarging Squamous Inclusion Cyst in an Axillary Lymph Node following Core Needle Biopsy

A 73-year-old woman was found to have a 1.7 cm axillary mass, for which a core needle biopsy was performed. The specimen revealed fragmented squamous epithelium surrounded by lymphoid tissue consistent with a squamous inclusion cyst in a lymph node, but a metastatic squamous cell carcinoma could not be excluded. Within one month, the lesion enlarged to 5 cm and was excised. Touch preparation cytology during intraoperative consultation displayed numerous single and sheets of atypical epithelioid cells with enlarged nuclei and occasional mitoses, suggesting a carcinoma. However, multinucleated giant cells and neutrophils in the background indicated reactive changes. We interpreted the touch preparation as atypical and recommended conservative surgical management. Permanent sections revealed a ruptured squamous inclusion cyst in a lymph node with extensive reactive changes. Retrospectively, the atypical epithelioid cells on touch preparation corresponded to reactive histiocytes. This is the first case report of a rapidly enlarging ruptured squamous inclusion cyst in an axillary lymph node following core needle biopsy. Our case demonstrates the diagnostic challenges related to a ruptured squamous inclusion cyst and serves to inform the readers to consider this lesion in the differential diagnosis for similar situations.

Postchemotherapy-related changes in mediastinal mixed germ cell tumor masquerading as a vascular neoplasm

Florid vascular proliferation in teratoma is rare morphological presentation. We present a case of mediastinal germ cell tumor masquerading as a vascular neoplasm in a 14-year-old male who presented with right hemithoracic mass. The initial histopathology of resected mass was suggestive of vascular neoplasm. Fine needle aspiration cytology (FNAC) of right axillary mass with immunohistochemistry on cell block was consistent with metastatic mixed germ cell tumor. Repeat extensive sectioning of the resected mediastinal mass showed focal viable tumor with mainly teratomatous component. Further enquiry into the history revealed patient having received prior chemotherapy; this he received in another hospital before being admitted to our hospital for surgical resection of the mass. The florid vascular proliferation may represent postchemotherapy change or a rare component of germ cell tumor possibly resistant to preoperative chemotherapy.

Toxoplasmic Lymphadenopathy Presenting as a Palpable Axillary Mass - A Case Report

Toxoplasmic Lymphadenopathy Presenting as a Palpable Axillary Mass - A Case Report

Osseous Metaplasia in Castleman's Disease: A Case Report

Background. Castleman's disease is a benign lymphoproliferative disorder. The disease may be localized or multicentric. Three histologic variants are recognized: hyaline vascular, plasma cell, and mixed types. Case. A 20-year-old man presented with large left axillary mass. The histologic examination of the resected mass showed follicular pattern with large nodules of mantle cells arranged concentrically around atrophic and vascularized germinal centers. There was also some benign-appearing bone trabeculae interspersed with lymphoid tissue. The diagnosis of Castleman's disease, hyaline-vascular type with osseous metaplasia, was made.

Unusual Location of Hydatid Cysts: A Case Report and Literature Review

Hydatid cysts develop most frequently in the liver and lungs, but they are occasionally found in other organs. Hydatid cysts in the axillary space are an extremely rare event in areas where the disease is endemic, and are still common in many countries, including Turkey. A 73-year-old man presented to our clinic with a painful axillary mass. Thoracoabdominal computed tomography revealed multilocular cystic masses localized in the left axillary space, with minimal invasion of the peripheral soft tissue and no pulmonary or hepatic involvement. An echinococcal indirect hemagglutination test was negative. The masses were dissected through their stalks and removed completely. Macroscopic and microscopic examination of the specimens confirmed hydatid cysts. This case report demonstrates that hydatid cysts should be considered as a possible cause for palpable lesions in the axillary region or chest wall, especially in endemic locations.

Burkitt Lymphoma Presenting as Unilateral Deafness in an Immunocompetent Patient

A 55-year-old HIV-negative white male presented with right ear deafness, right axillary lymphadenopathy, and weight loss. Laboratory findings included anemia, marked leukocytosis, and thrombocytopenia. Examination of the peripheral smear demonstrated the presence of increased circulating blast-like cells of intermediate size, with basophilic cytoplasm and nuclei with open chromatin. MRI of the brain was compatible with hemorrhagic labyrinthitis. Excisional biopsy of the axillary mass revealed an enlarged lymph node with effaced architecture and “starry sky” appearance. The cells expressed CD20, CD10, BCL6, and surface kappa immunoglobulin light chain, with a high proliferative index by immunohistochemistry and flow cytometry. Subsequent bone marrow biopsy was hypercellular (approximately 95%), with blast-like cells virtually replacing all hematopoietic elements. Routine karyotype as well as FISH analysis of bone marrow cells demonstrated rearrangement of the MYC gene at chromosome 8q24 region, IGH/MYC fusion, and additional signal for IGH gene. We present herein a case of sporadic Burkitt lymphoma occurring in a previously healthy HIV-negative male. The unusual clinical findings in this case include the relatively older age at presentation (55 years), an immunocompetent patient who had nodal involvement and leukemic phase of Burkitt, coupled with partial deafness. A brief educational review of this neoplasm is made.

Interdigitating dendritic cell sarcoma occured alone in axilla

Interdigitating dendritic cell sarcoma (IDCS) is a very rare disease around the world and its prognosis is known to be aggressive. This reports a case diagnosed as IDCS of the axillary region treated in Soonchunhyang University Hospital. A 57-year-old female visited Soonchunhyang University Hospital with a left axillary mass. The mass was hard and fixed. Computed tomography observed a 7 cm lymph node at the left axilla, and core biopsy suspected sarcoma. In another study, there was no specific finding except the axillary lesion. Left axillary lymph node dissection (level I, II) was conducted and the pathologic report finally showed IDCS. The patient was treated with only radiotherapy and followed up without recurrence for 13 months up to now. IDCS is a very rare sarcoma that is hard to diagnose and progresses fast. Thus, treatment is very difficult. Proper treatment can be better established after more experiences.

Sarcoid-like reaction in breast cancer: a long-term follow-up series of eight patients

Finding an intrathoracic or axillary mass in a breast cancer patient should raise suspicion of a pulmonary or mediastinal nodal metastasis or axillary recurrence. Surprisingly, noncaseating epithelioid cell granuloma can be found in this type of lesion, as in sarcoidosis or a sarcoid-like reaction. This series included eight breast cancer patients in whom a late sarcoid-like reaction developed: as an intrathoracic lesion in six, and as an ipsilateral axillary lesion in two. The latency period from oncological surgery to the diagnosis of sarcoidosis was 40months and the average follow-up after the diagnosis of sarcoidosis was 63.38months. None of the patients suffered relapse or oncological events during the period of this study. To avoid misdiagnosis and overtreatment, pathological examination should always be carried out. We do not recommend any specific treatment for sarcoidosis in a breast cancer patient, but routine oncological follow-up is appropriate. A larger series with statistical analysis is necessary to evaluate the prognosis.

Fibroadenoma of the Axilla in A Patient With Macroprolactinoma

Ectopic breast tissues may be affected by to the same physiological and pathological alterations seen in the normal breast, including fibroadenoma. We report a 30-year-old nulliparous woman who presented with a left axillary lump, for which clinical impression of axillary lymphadenopathy was made. She was receiving treatment with cabergoline due to a prolactinoma with galactorrhea for some years, but her serum prolactin levels were still high. The patient underwent surgical resection of the nodule and the histology was identical to the fibroadenomas seen in the breast. To the best of our knowledge, this is the first report of fibroadenoma of the axilla in a patient with a macroprolactinoma. fibroadenoma in an ectopic breast tissue must be kept in mind in the differential diagnosis of axillary mass. doi:10.4021/jmc384w

Metastatic Melanoma With Striking Adenocarcinomatous Differentiation Illustrating Phenotypic Plasticity in Melanoma

We report on the highly unusual case of a 75-year-old woman who developed a biphasic right axillary mass of apparent melanoma and adenocarcinoma 13 years after a diagnosis of primary melanoma on her right upper back. The differential diagnosis included a collision tumor and metastatic melanoma with adenocarcinomatous transdifferentiation. We utilized immunohistochemical staining, DNA sequencing, and comparative genomic hybridization (CGH) to characterize this unusual tumor. By immunohistochemistry, the melanomatous component was positive for S100 and Melan-A, and had patchy positivity for cytokeratin. The adenocarcinomatous component was negative for melanoma markers, but was strongly positive for cytokeratin. In addition, the glandular component was positive for CDX-2 and Ber-EP4, giving the distinct histologic and immunohistochemical impression of a gastrointestinal metastasis nested within a deposit of metastatic melanoma. Clinical and radiologic workup failed to reveal a primary gastrointestinal malignancy. Molecular genetic analysis, including DNA sequencing and CGH, revealed that both areas contained an identical NRAS Q61K mutation and had highly similar CGH profiles, including gains of chromosome 1q and losses of 1p, 4, 9, and 10, which are archetypical of melanoma. The NRAS mutation was also identified in a deposit of metastatic melanoma resected 12 years earlier, but was not seen in the patient's nontumorous tissue, indicating that it was somatically acquired. Genetic analyses demonstrate that 2 morphologically distinct tumors arose from a common ancestor melanoma cell that harbored an NRAS mutation and subsequently divergently evolved by the acquisition of additional genomic alterations. Our findings illustrate the ability of molecular analyses to resolve lineage in complex neoplasms and illustrate the phenotypic plasticity of cancer cells.

Benign Epithelial Inclusions in Axillary Lymph Nodes

The occurrence of various types of heterotopic epithelial structures in lymph nodes is a well-documented phenomenon. Here, we report on the presence of such inclusions in axillary lymph nodes. A total of 18 cases were identified. All patients were women, their ages ranging from 32 to 79 years (median, 57 y). Thirteen patients had concomitant or antecedent breast abnormalities, and 12 of them had undergone nodal sampling for staging purposes. The other 5 patients had noted enlarging axillary masses, with no clinical evidence of previous or concomitant breast or genital tract pathology. We classified the nodal inclusions on morphologic grounds into 3 main categories: those composed exclusively of glandular structures (glandular-type inclusions; 10 cases, 56%); those made up only of squamous cysts (squamous-type inclusions; 2 cases, 11%); and those containing both glandular and squamous epithelia (mixed glandular-squamous-type inclusions; 6 cases, 33%). We speculate about the possible mechanism for the migration of the epithelial cells into the lymph nodes, discuss the modifications that they may later undergo as a result of local and systemic factors, and consider the differential diagnosis with other conditions, particularly with metastatic well-differentiated breast carcinoma.

US Findings of Various Axillary Masses

US Findings of Various Axillary Masses

Diagnosis and treatment of occult breast cancer in 44 cases

To summarize the experience of diagnosis and treatment of occult breast cancer in 44 cases. Clinicopathological data of 44 cases of occult breast cancer initially presenting axillary mass alone treated in our department during Jan 1997 to Dec 2008 were retrospectively analyzed. The 44 patients with occult breast cancer accounted for 0.42% of all breast cancer patients admitted to our hospital and institute in the same period. The surgery included radical mastectomy in 16 cases, modified radical mastectomy in 19 cases, axillary clearance in 1 case, and simple axillary node excision in 8 cases. Follow-up, ranging from 12-132 months, was available in 38 cases. Among 32 cases who underwent mastectomy or axillary clearance, 2 cases died of distant metastases and 3 cases were still alive with local recurrence at the time of analysis. In two out of six cases who refused further surgical treatment received mastectomy 16 months and 41 months after the primary diagnosis of occult breast cancer, respectively. Others were alive without evidence of recurrence or metastases at the time of analysis. Occult breast cancer should be taken into consideration in cases presenting with axillary metastasis of unknown primary origin. The treatment of occult breast cancer should include modified radical mastectomy/radical mastectomy or breast conserving surgery combined with breast irradiation.

Lymphangioma in an Elderly Patient: An Unusual Cause of Axillary Mass

The Breast JournalVolume 17, Issue 4 p. 416-417 BREAST IMAGES Lymphangioma in an Elderly Patient: An Unusual Cause of Axillary Mass Kim Nguyen DO, Kim Nguyen DO Department of Surgery, New York Hospital Queens, Flushing, NYSearch for more papers by this authorKaren Karsif MD, FACS, Karen Karsif MD, FACS Department of Surgery, The Breast Center, New York Hospital Queens, Flushing, NYSearch for more papers by this authorSusan Lee MD, FACOG, FACS, Susan Lee MD, FACOG, FACS Department of Surgery, The Breast Center, New York Hospital Queens, Flushing, NYSearch for more papers by this authorKornylo Chorny MD, Kornylo Chorny MD Department of Radiology, New York Hospital Queens, Flushing, NYSearch for more papers by this authorMargaret Chen MD, FACS, Margaret Chen MD, FACS Department of Surgery, The Breast Center, New York Hospital Queens, Flushing, NYSearch for more papers by this author Kim Nguyen DO, Kim Nguyen DO Department of Surgery, New York Hospital Queens, Flushing, NYSearch for more papers by this authorKaren Karsif MD, FACS, Karen Karsif MD, FACS Department of Surgery, The Breast Center, New York Hospital Queens, Flushing, NYSearch for more papers by this authorSusan Lee MD, FACOG, FACS, Susan Lee MD, FACOG, FACS Department of Surgery, The Breast Center, New York Hospital Queens, Flushing, NYSearch for more papers by this authorKornylo Chorny MD, Kornylo Chorny MD Department of Radiology, New York Hospital Queens, Flushing, NYSearch for more papers by this authorMargaret Chen MD, FACS, Margaret Chen MD, FACS Department of Surgery, The Breast Center, New York Hospital Queens, Flushing, NYSearch for more papers by this author First published: 14 June 2011 https://doi.org/10.1111/j.1524-4741.2011.01103.xCitations: 6 Address correspondence and reprint requests to: Margaret Chen, MD, FACS, Assistant Director, The Breast Center, Assistant Professor of Clinical Surgery, Weill Medical College of Cornell University, New York Hospital Queens, 56-26 Main Street, Flushing, NY 11355-5095, USA, or e-mail: mac9237@nyp.org. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume17, Issue4July/August 2011Pages 416-417 RelatedInformation

Histiocytic Sarcoma Involving Lymph Nodes

This report of an 82-year-old man who presented with a 3-week history of an enlarging left axillary mass and mild fevers, highlights the usefulness of both gallium-67 and F-18 FDG PET/CT imaging in the staging of histiocytic sarcoma. While PET/CT was superior in determining the extent of the disease, gallium can be used to help stage the disease in centers where PET/CT is not available.

Intra-ocular melanoma metastatic to an axillary lymph node: A case report

BackgroundUnusual metastatic presentation of intra-ocular melanoma.Study DesignCase report.DiscussionExtra-regional lymphatic spread of intra-ocular melanoma has not been reported previously in the literature. The usual pattern of metastasis for intra-ocular melanoma is hematogenous. There are few reports of regional spread to the maxillofacial bones. We report an interesting case of a 51 year old female with prior history of right eye melanoma, now presenting with metastasis to the left axilla, which is an extra-regional nodal basin.ConclusionIn female patients presenting with an isolated axillary mass, with a negative breast work up and known prior history of melanoma, the differential diagnosis should include possible metastatic melanoma. Core biopsy will confirm the diagnosis and tailor subsequent management.