Axillary Swelling Research Articles

Rare Case of Lymphoma Presenting as Axillary Swelling

Rare Case of Lymphoma Presenting as Axillary Swelling

Rosai Dorfman Disease: A Rare Disease Case Report

Rosai Dorfman Disease (RDD) is a rare benign condition. It was first described by Rosai and Dorfman in the 1960s. The etiology, pathogenesis and true frequency of the disease remain unknown. The disease is characterized by the proliferation of histiocytes in the lymph nodes. Clinically, this enlargement of the lymph nodes must be distinguished from other infectious or malignant causes. Although it is often observed at early ages, in this study, a case of RDD detected in a 66-year-old male patient who came to the hematology outpatient clinic due to axillary swelling was presented. The patient is still being monitored without any symptoms,without treatment.

Accessory breast tissue-A matter for exigence!

The accessory breast tissue is found in 6%. It is seen commonly in the axilla. It is asymptomatic or causes pain, restricts arm movement, causes cosmetic problems, or causes anxiety. We evaluated symptoms, signs, investigations, treatment, and postoperative complications of women with accessory breast tissue. Our cross-sectional study was conducted in the Surgery OPD, Nagpur, on 52 women who presented with accessory breast tissue in the period from January 2019 to October 2023. In this study, of 52 patients, the majority, that is, 38 (73.07%) patients, presented with uneasiness due to the position of mass followed by 25 (48.07%) with swelling in the axilla. Twelve (23.07%) patients presented with pain in mass in premenstrual and menstrual periods, and seven (13.46%) patients with accessory nipples. Fifty (96.15%) patients had axillary swelling. One (1.92%) patient each had swelling in groin and thigh. Thirty-six (69.2%) patients had sonography findings consistent with breast-like tissue. In nine (17.30%) patients, findings suggested lipoma. Surgical excision was conducted in 52 (100%) patients. In 43 (82.69%) patients, histopathology was consistent with simple breast tissue. In six (11.53%) patients, it was fibroadenoma, and in three (6.76%) patients, histopathology was suggestive of carcinoma. Twenty-eight (53.84%) patients had no complications. Thirteen (25%) patients had an allergy to sticking, six (11.53%) patients had uneven scar, and four (7.69%) patients had hypertrophy of scar. In our study, in the majority of patients, the site of accessory breast tissue was axilla. It caused uneasiness. Surgical excision was conducted in all patients. Postoperative complications were the least.

Breast Imaging of Axillary Supernumerary Breast: About a Clinical Case

Axillary breast is a subject that is poorly studied in the medical literature. We report the case of a 41-year-old woman who consulted for a painful right axillary mass, increasing in volume during menstrual cycles. The clinical examination revealed a 3 cm diameter axillary swelling, mobile, soft, without inflammatory signs or discharge. The mammography showed a dense and homogeneous area in the right axillary region, corresponding to an ectopic mammary glandular parenchyma. The ultrasound confirmed the presence of an axillary fibroglandular component, without focal anomaly or adenopathy. The diagnosis of accessory axillary breast was retained. This case illustrates the interest of imaging for the diagnosis and assessment of the accessory axillary breast, a rare anomaly but potentially at risk of neoplastic degeneration.

Characterization of Axillary Lymph Nodes Using Conventional Ultrasonography Compared with Histopathological Findings

A cross-sectional, observational study was carried out the Department of Radiology and Imaging, Combined Military Hospital (CMH) at Dhaka Cantonment, Bangladesh, between March and August of 2021. A total of 75 female patients were included presenting with or without axillary swelling referred for ultrasound of breasts and axilla from various surgical and medical departments of the same hospital. B-mode ultrasonography was used as method of choice because of its noninvasiveness and availability in evaluating the axillary lymph nodes. Histopathological diagnosis was considered the gold standard for the diagnosis. The average age was 42.62±8.76 years. In conventional ultrasonography results, 33.3% were benign lymph node, 14.7% were reactive and 52% were metastatic lymph node. Based on the histopathological reports, lymph node involvement was detected in 18(24%) patients with benign, 13(17.3%) patients reactive and 44(58.7%) metastatic. The overall results revealed 79.5% sensitivity, 87.1% specificity, 89.7% PPV and 75% NPV. To summarize, conventional ultrasonography was moderately sensitive with good specificity for diagnosis of axillary lymph node. Further studies with a larger population and intra-operative axillary lymph node are recommended. CBMJ 2024 January: vol. 13 no. 01 P: 3-8

Role of immunohistochemistry in clinicohistopathology-A rare case study

Disease affecting Lymph nodes form wide range of spectrum from simple to malignant pathology. Such cases are an important element to rule out malignancy in early stages. However Generalised Lymphedenopathy diagnosis become huge challenge. Hence, an insight into clinocohistopathological correlation with help of IHC markers becomes highly important to decide morphologic differential diagnosis.: To study lymph node lesions with clinicohistopathological correlation with the help of IHC study. This is a combined observational and prospective study held in District hospital Vijayapur during August 2022 to September 2023. Patient details were taken with the questionnaires. During his first visit clinical examinations and investigations, CBC, PS study, FNAC of left lower cervical region, Urine routine, chest X-ray & USG of abdomen performed and patient was analyzed & diagnosed as Chronic appendicitis and treated. During patient’s second visit, clinical examinations and investigations CBC, PS study, FNAC of left Axillary swelling, Urine routine, chest X-ray, USG of neck & abdomen, CT Neck & abdomen, USG guided FNAC of Liver, Bone marrow aspiration study, Biopsy of left lower Cervical lymph node for Histopathology study & IHC study performed. Case was studied using routine H&E, PAP stain slides of Biopsy material were evaluated by light microscopy. And for IHC, patient biopsy material referred to higher center, using specific monoclonal or polyclonal antibodies, paraffin sections were stained immunohistochemically (IHC) using a Peroxidase antiperoxidase (PAP) technique in referred higher center. Patient was diagnosed as B-cell Lymphoma as per WHO guidelines with the help of IHC markers.: From this study, concluded that IHC plays a significant role clinicopathology and helped in the definitive diagnosis and typing of tumours and appropriate treatment can be planned.

Contribution of Computed Tomography in the Diagnosis of Multifocal Non-Hodgkin’s Lymphoma at the Mother-Child University Hospital the ‘’Luxembourg’’ About a Case

Lymphoma is a malignant proliferation of lymphoid tissue cells. We report a case of multi-focal lymphoma of lymph node, pharyngeal, cardiac and splenic sites. This was a 19-year-old patient received in February 2023, at the radiology and medical imaging department of the Mother and Child University Hospital Center ''Luxembourg'' as part of the CT exploration of a lateral mass. -left cervical. On admission, the clinical examination found a patient with an altered general condition, moderately colored conjunctiva, normal blood pressure and temperature. Examination of the lymph node areas revealed a left latero-cervical swelling, and fixed bilateral axillary swellings, of firm consistency and irregular contours. Palpation revealed hepatosplenomegaly. Cardiopulmonary auscultation was normal. A cervico-thoraco-abdominal CT scan revealed irregular thickening of the left lateral wall of the oropharynx, a hypodense tissue mass in the right cardiac chambers, heterogeneous splenomegaly, cervical, mediastinal, axillary and abdominal ADP. The histological examination carried out after lymph node biopsy revealed a histological appearance of small cell lymphoma. Conclusion: Lymphoma is a very common malignant tumor that can occur at any age. This tumor can affect all organs, however its cardiac location is rare. The positive diagnosis remains histological. Imaging plays an important role in the initial assessment, extension and surveillance.

Spectrum of Unusual Cytomorphology of Axillary Swellings: A Series of Four Cases

The axilla is a triangular area situated anatomically beneath the shoulder joint, between the upper arm and thorax. It contains lymph nodes and numerous non lymphatic tissues such as neurovascular structures, muscle, and fat. Axillary swellings can arise from any of these mesenchymal soft tissues. Fine Needle Aspiration Cytology (FNAC) is the first-line investigative technique widely used in evaluating axillary swellings, as it is a simple outpatient procedure that causes minimal complications, unlike core biopsy, which is invasive and carries a high-risk of bleeding. Hereby, the authors present a case series of four unusual cases: bilateral accessory breast tissue (32-year-old female), bilateral galactocele (28-year-old female), unilateral galactocele (24-year-old female), and fibroadenoma (35-year-old female) in the axilla, all of which were cytomorphologically diagnosed with the aid of FNAC. Axillary lumps can present with a variety of unusual lesions and can pose a significant diagnostic challenge to a clinicians. Although histopathology of the biopsy of the lesion remains the gold standard, clinical features along with imaging can aid in the diagnosis with better patient compliance.

Bacillus Calmette-Guérin Adenitis: An Intriguing Series of Four Cases

Bacille Calmette-Guérin (BCG) vaccine is part of the immunisation schedule in India. It is a live-attenuated vaccine with very few adverse reactions, one of which is BCG adenitis. The intriguing fact is that there has been a sudden upsurge in the number of BCG adenitis cases (two males and two female children), with four reported cases within three months (March 2023-June 2023). There were two male and two female children, aged between 2-8 months. All of them presented with left axillary swelling, and all but one had low grade fever only in the initial days. They all had a healed BCG vaccination scar on their left arm. Fine Needle Aspiration Cytology (FNAC) showed multiple epithelioid granulomas and, in some cases, frank caseation necrosis with the demonstration of tubercle bacilli using either Ziehl-Neelsen (Z-N) stain or Cartridge-based Nucleic Acid Amplification Test (CBNAAT). These cases mostly benefited from pus aspiration from the swelling site, with no definite role for oral antibiotics. Proper training of nursing or paramedical staff regarding vaccination technique and dosage, proper maternal and child healthcare, early detection of these cases with a high index of suspicion, as well as adequate knowledge of the treating doctors and parents/caregivers, may help in prompt management of these cases in future occurrences.

Assessment of peripheral lymph node tuberculosis: a prospective study of 24 cases

Abstract Introduction: Tubercular lymphadenitis which comes under Extra-pulmonary Tuberculosis (EPTB) has been affecting mankind since ancient times. Peripheral lymph node involvement is the commonest form of EPTB among which cervical lymph nodes are most frequently affected. Objectives: The aim of this study was to evaluate the demographic, clinical characteristics and treatment outcomes of peripheral lymph node Tuberculosis cases in a rural tertiary health care centre. Methods: The study was conducted prospectively at Prathima Institute of Medical Sciences, Nagunur, Karimnagar between January 2021 to August 2022. Pathologically confirmed cases of lymph node Tuberculosis were assessed and followed up. Results: 24 cases of lymph node TB were included with 83.3% females and 16.6% males (p=0.02) with a mean age of 32.6 ± 15.24 years. The mean age among males was 37 ± 15.59 years and among females was 31.75 ± 15.24 years. 58.3% were from rural areas. All of them presented with a history of swelling, 37.5% had a fever, 50% had a loss of appetite and 54.1% had a loss of weight. 8% had a past history of tuberculosis. 79.1% had cervical swelling and 20.8% had axillary swelling. 83.3% had multiple lymph nodes and 33.3% had lymph node matting. Three cases were lost to follow-up, 79% improved with standard anti-Tuberculosis treatment (ATT) and one case died during treatment. Conclusion: Lymph node TB is still prevalent in TB endemic countries and has to be considered first in the differential diagnosis of peripheral lymph node swellings.

WTP1.12 Axillary Artery Aneurysm in a Patient of Achondroplasia

Abstract Background Axillary artery aneurysms are extremely rare mainly occurring as pseudo-aneurysms. They are most commonly caused by trauma however; fungal infections, atherosclerosis, connective tissue diseases, vasculitis and thoracic outlet syndrome are also among the etiological factors. Case Summary Seventeen years old, unmarried, achondroplasic (three feet height) girl presented to OPD with pulsatile swelling and pian in right axilla for six months. Pain was accompanied by weakness and numbness of hand. The swelling was initially small in size which increased over time. Patient had history of left axillary artery aneurysm back in 2015 for which left axillary repair was done. There was no history of axillary trauma. On physical examination an approximately 4×2 cm lump was palpable in right axilla. It was round in shape, mobile, pulsatile and non-expanding with no overlying skin changes. The patient had hypotonia with power of 3/5 in all limbs. Deep tendon reflexes were reduced. Rest of systemic examination was unremarkable. CT angiography was done which showed brachiocephalic trunck and right proximal subclavian artery normal. There was a lobulated enhancing area along the course of the Right axillary artery measuring 3.5×4.7×3.0 cm. The axillary artery aneurysm was excised and arterial continuity was restored by placement of Reverse Saphenous vein graft. Discussion The conventional method of axillary artery aneurysm repair is aneurysmectomy followed by placement of bypass graft. Owing to long term patency, saphenous vein graft serves as an ideal for reconstruction. Conclusion axillary artery aneurysms should be considered as a differential for pulsatile axillary swellings and should be promptly treated to avoid life threatening complications.

Induction of Axillary Bud Swelling of Hevea brasiliensis to Regenerate Plants through Somatic Embryogenesis and Analysis of Genetic Stability.

To overcome rubber tree (RT) tissue culture explant source limitations, the current study aimed to establish a new Hevea brasiliensis somatic embryogenesis (SE) system, laying the technical foundation for the establishment of an axillary-bud-based seedling regeneration system. In this study, in vitro plantlets of Hevea brasiliensis Chinese Academy of Tropical Agricultural Sciences 917 (CATAS 917) were used as the experimental materials. Firstly, the optimum conditions for axillary bud swelling were studied; then, the effects of phenology, the swelling time of axillary buds (ABs), and medium of embryogenic callus induction were studied. Plantlets were obtained through somatic embryogenesis. Flow cytometry, inter-simple sequence repeat (ISSR molecular marker) and chromosome karyotype analysis were used to study the genetic stability of regenerated plants along with budding seedlings (BSs) and secondary somatic embryo seedlings (SSESs) as the control. The results show that the rubber tree's phenology period was mature, and the axillary bud induction rate was the highest in the 2 mg/L 6-benzyladenine (6-BA) medium (up to 85.83%). Later, 3-day-old swelling axillary buds were used as explants for callogenesis and somatic embryogenesis. The callus induction rate was optimum in MH (Medium in Hevea) + 1.5 mg/L 2,4-dichlorophenoxyacetic acid (2,4-D) + 1.5 mg/L 1-naphthalene acetic acid (NAA) + 1.5 mg/L Kinetin (KT) + 70 g/L sucrose (56.55%). The regenerated plants were obtained after the 175-day culture of explants through callus induction, embryogenic callus induction, somatic embryo development, and plant regeneration. Compared with the secondary somatic embryo seedling control, axillary bud regeneration plants (ABRPs) were normal diploid plants at the cellular and molecular level, with a variation rate of 7.74%.

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.

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.

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.

Case presentation of axillary swelling as hydatid cyst

Case presentation of axillary swelling as hydatid cyst

Primary ectopic breast carcinoma: a case report

BackgroundEctopic breast tissue is present in 2–6% of women. Ectopic mammary tissue can experience physiological changes and the same pathological processes as the eutopic breast. Ectopic breast cancer represents an uncommon condition accounting for 0.3% of all breast neoplasms, and it is most frequently located in the axilla.Case reportWe report a rare case of a 57-year-old Tunisian woman who presented with a left-sided axillary mass evolving for about 1 month. The axillary ectopic breast tissue containing the mass was excised with axillary dissection. Pathology revealed a medullary multifocal carcinoma and metastasis was detected in two lymph nodes. She had local radiotherapy after six cycles of chemotherapy. She received herceptin therapy and hormonotherapy. After a 2-year follow-up, no evidence of local recurrence or distant metastases have been identified.ConclusionEctopic breast carcinoma is a rare entity that should be the first diagnosis to be considered if an axillary lump is present in ectopic breast tissue. No particular guidelines on diagnosis and treatment are available. Therefore, physicians should be aware of this condition to avoid treatment delays. Once diagnosed, careful patient follow-up is essential because of the ambiguous natural history of this rare entity.

TB or not TB? The axillary lump question

An 81-year-old woman of healthy weight presented with a 2-week history of a painless right axillary lump. Physical examination revealed a 2cm firm nodule with a central keratinous plug in the right axilla (Fig. 1). The surrounding skin was pigmented, non-tender and indurated. Sonography of the nodule demonstrated an underlying ill-defined cystic collection containing mobile

P486 Disseminated Cryptococcosis diagnosed on fine needle aspiration cytology

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PMObjectives (Case)A 48-year-old male with no prior comorbidities presented to our infectious disease clinic with intermittent low-grade fever and gradual progressive swelling in his left axilla for 3 months. On further probing, the patient also gives a history of weight loss of around 7 kg. The patient belonged to a northern state of the Indian subcontinent and owned a grocery shop, where he worked. There was no recent or remote travel history, no history of exposure to animals or birds, no high-risk behavior, and no past or known contact history of tuberculosis. Still, in an endemic country like India and in this given clinical scenario, we kept tubercular lymphadenitis as the first differential and investigated the case further.Methods (Investigation)A contrast-enhanced computed tomography (CECT) of the chest and abdomen was done, showing multiple enlarged mediastinal and axillary lymph nodes with bilateral adrenal mass (Fig. 1). To further evaluate the etiology, a fine needle aspiration of the left axillary swelling was done. A hematoxylin and eosin (H and E) stain of the same showed the presence of numerous organisms of varying sizes present both intracellularly and extracellularly along with chronic inflammatory cells (Fig. 2a). Based on this picture, differentials of Histoplasma, Cryptococcus, or Toxoplasma were kept. But considering the empty spaces (halos) which probably represent the capsule and variability in the size, a strong possibility of Cryptococcus was kept. Serum cryptococcal antigen (latex agglutination) was negative but eventually, the fungal culture of the aspirated sample grew cream-colored, shiny dome-shaped, mucoid colonies on Sabouraud Dextrose Agar suggestive of Cryptococcus (Fig. 2b). The same was confirmed on Bird Seed Agar and Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (MS). Gene Xpert of the aspirated sample was negative and serum cortisol with serum adrenocorticotropic hormone (ACTH) were under normal limits.Results (Diagnosis)A diagnosis of disseminated cryptococcosis was made based on the involvement of more than two non-contiguous sites (mediastinal with axillary lymph nodes and adrenal gland). The patient was initially started on liposomal Amphotericin B (5 mg/kg intravenous daily) with which he improved clinically. Same was continued for 2 weeks and later he was shifted to fluconazole 400 mg daily. As of now, the patient is on his 3rd month of fluconazole and doing well on follow-up.ConclusionCryptococcus (Cryptococcus neoformans and Cryptococcus gattii) is an encapsulated yeast causing invasive fungal infection, with vast majority occurring in immunocompromised host1. It has a global distribution, predominantly involving the central nervous system (CNS) and lung. Management of non-CNS and non-pulmonary cryptococcosis is tricky as looking for dissemination is key (as the initial choice of agent varies)2. Adrenal involvement in Cryptococcosis is uncommon (as seen in our case). Examination of FNAC samples for Cryptococcus is also challenging as other microbes can also closely mimic the same. Finally, in a tuberculosis endemic country like India, clinical symptoms of Cryptococcal lymphadenitis can closely resemble tubercular lymphadenitis, so empirical therapy may be risky.Figure 1 Axial CT Chest images showing multiple enlarged mediastinal lymph nodes (red arrow).Figure 2a Fine needle aspiration cytology (FNAC) from the left axillary swelling stained with hematoxylin and eosin showing numerous organisms of varying size present both intracellularly (black arrow) and extracellularly with surrounding halos in a background chronic inflammatory cells.Figure 2b Fine needle aspirate sample incubated at 37 0C on Sabouraud Dextrose Agar with gentamicin showing cream-colored, dome-shaped, shiny, mucoid colonies with smooth edge (characteristic of Cryptococcus).Sources:Iyer KR, Revie NM, Fu C, Robbins N, Cowen LE. Treatment strategies for cryptococcal infection: challenges, advances and future outlook. Nat Rev Microbiol. 2021 Jul;19(7):454–66.Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America | Clinical Infectious Diseases | Oxford Academic [Internet]. [cited 2022 Jul 28]. Available from: https://academic.oup.com/cid/article/50/3/291/392360

Fibroadenoma in axillary accessory breast tissue: a case report

BackgroundAccessory breast(s) is defined as the presence of more than two breasts with or without a nipple and areola in human beings. It may occur anywhere along the primitive embryonic milk lines, which extend from the axilla to the groin. Accessory breast tissue can potentially undergo the same physiological and pathological processes as the normally located breast, including lactational change, fibroadenoma, and carcinoma. Although common in the normally located breast tissue, the incidence of fibroadenoma in accessory breast tissue is rare. Furthermore, if the swelling occurs in the axilla or groin, it may present a diagnostic challenge by clinically mimicking a lymphoma or other causes of lymphadenopathy. Owing to its rarity and its tendency to pose a clinical diagnostic challenge, we decided to report a case of fibroadenoma in axillary accessory breast.Case presentationA 28-year-old Ethiopian female patient came to University of Gondar comprehensive specialized hospital with a complaint of left axillary swelling of 3 years duration. There was no history of cough, fever, weight loss, or night sweating. On physical examination, there was an approximately 5 × 4 cm, firm, well-defined, mobile, nontender solitary mass in the left axilla that was completely separated from the left breast. Fine-needle aspiration cytology suggested a diagnosis of fibroadenoma in axillary accessory breast tissue. The mass was completely excised, and histopathologic examination confirmed the diagnosis. Her recovery was uneventful. She was informed about the diagnosis, reassured, and discharged from care.ConclusionIn the clinical evaluation of a patient with axillary swelling, accessory breast tissue disorders such as fibroadenoma must be considered as a differential diagnosis for early diagnostic workup and management. Moreover, this case underscores the fact that, similar to normal breast tissue, accessory breast tissue is also susceptible to the same pathologic disease processes including neoplasms such as fibroadenoma.