Axillary Lymph Node Enlargement Research Articles

Metastasis of ovarian cancer to the breast: A report of two cases and a review of the literature

Metastasis of ovarian cancer to the breast (MOCB) is a rare event. Clinical presentations of MOCB vary and surgery is the mainstay of treatment. The current study presents two cases of MOCB in women with recurrent ovarian cancer first diagnosed in April 2011 and October 2013, respectively. The patients presented to the clinic with a localized, palpable, painful mass in the upper outer quadrant of the right breast and a centrally localized, palpable, painful mass of the left breast, respectively. Breast sonography and mammography showed a singular, round, homogenous tumor with irregular borders in each case. An ipsilateral enlarged axillary node was palpable in one case. Tumor biopsy revealed an undifferentiated adenocarcinoma of unknown origin in one case and a moderately-differentiated adenocarcinoma suspected to be breast cancer in the other case. Tumor cells were positive for estrogen receptor and paired box 8, and negative for GATA binding protein 3 in the two cases. Palliative mastectomy was performed in one case and lumpectomy with ipsilateral axillary sentinel node biopsy in the other case, and the final histology revealed MOCB in each. The post-operative course of the disease was uneventful and the patients continued with their ovarian cancer-specific chemotherapy. One patient succumbed to disease progression 2 months after breast surgery. The other patient remains alive and is currently undergoing systemic chemotherapy. The current study also presents a review of 110 cases of MOCB identified in a literature search of Pubmed. Data from these studies, including the clinical and histological characteristics of MOCB, and the clinical management and prognosis are discussed. Overall, MOCB is rare, with distinct clinical and histological features. The disease is usually treated with local surgical excision or mastectomy and has a poor prognosis.

Eyelid Swelling and Proptosis with Systemic Implications

PRESENTATION A 20-year-old woman presented with a 4-day history of left upper eyelid swelling with erythema and tenderness (Figure 1). Two months prior to presentation, she had a similar episode on the left side, which was diagnosed at an outside facility as a chalazion with associated preseptal cellulitis. Her symptoms resolved with 4 days of oral cephalexin. One month later, she developed similar symptoms on the right side. She was again diagnosed with preseptal cellulitis in the setting of a chalazion, and her symptoms resolved with 7 days of oral cephalexin. Her review of systems was positive for 3-4 years of intermittent joint swelling and pain. Initially, small joints, but recently also medium joints, were involved. The pain and swelling would occur in 1-2 joints for 1-2 weeks and then shift to another 1-2 joints. In addition, she noticed several enlarged cervical and axillary lymph nodes for the past 2 years. She also had dry mouth in the morning, but no significant dry eye symptoms. She noted no fever, chills, night sweats, or weight loss, but had chronic fatigue for 2 months. She also had mild chronic facial erythema that did not worsen with sun exposure. Her family history was notable for her mother having been affected by an unspecified connective tissue disease. On ophthalmologic examination, her visual acuity was 20/20 in both eyes, with normal color vision. Her pupils were normal, with no relative afferent pupillary defect. Her intraocular pressure was normal. She was orthophoric and had no subjective double vision. Right extraocular movements were full, but her left eye showed mildly limited abduction and supraduction. Her confrontation visual fields

57-Year-Old Man With Hip Pain and Lytic Bone Lesions

57-year-old man presented to his primary care physician with a 2-year history of progressive right hip pain. His medical history was notable for hyperlipidemia. He was up-to-date on sex- and agespecific cancer screening. The patient had no history of chest pain, palpitations, shortness of breath, cough, or other cardiac, respiratory, neurologic, or visual symptoms. He had no recent travel history or occupational or social contact with persons who were ill. Physical examination revealed an obese man (body mass index [calculated as weight in kilograms divided by height in meters squared], 40.34 kg/m 2 ) with normal vital signs and unremarkable findings on cardiac, respiratory, abdominal, neurologic, and lymphatic examination. No pain or tenderness was elicited on examination. He was treated initially with nonopioid pain medications. Sacroiliac corticosteroid injections were minimally beneficial. Results of a complete blood cell count (CBC) and electrolyte panel were normal with the exception of an elevated serum calcium level of 11.7 mg/dL (reference range, 8.9-10.1 mg/dL). Ultimately, magnetic resonance imaging (MRI) of his lumbar spine revealed numerous punched-out lytic lesions in the lumbar vertebra and pelvis. He underwent computed tomography (CT) of his chest, abdomen, and pelvis that identified further lytic lesions as well as multiple splenic lesions concerning for metastases. Two separate CT-guided bone biopsy samples of the lytic lesions in the lumbar vertebra did not elicit an etiology of the lesions.

Bacille Calmette-Guerin Lymphadenitis: A single center experience

To describe the clinical presentation, course and management of infants that presented with the diagnosis of lymphadenitis after Bacille Calmette-Guerin (BCG) vaccination. This is a descriptive study of 89 patients that were referred to the pediatric infectious disease clinic at King Hussein Medical Center in Jordan with regional lymphadenitis after BCG vaccination. The presentation, course and treatment options of these cases were discussed. The study was conducted between September 2006 and September 2007. Eighty-nine patients (47 males (53%) and 42 females (47%) were studied. All infants received the same type of vaccine used by our Ministry of Health, which is the Danish strain. Unilateral axillary lymph node enlargement was the most commonly seen (47%). Cervical lymph nodes were noted in 22 patients (25%) and supraclavicular lymphadenopathy was seen in 16 (18%). Sinus formation was seen in 16 (18%) patients. 27 cases (30%) had fluctuating lymph nodes. Four infants had disseminated infection. The majority (65%) of patients had their symptoms starting within the first 2 months after BCG vaccination. Forty-two (47%) infants had conservative observational management. Anti-tuberculosis medications were commenced in 27 (30%). Surgical excision was performed in 10 (11.5%) cases. All infants but one had complete recovery by the end of the study period. BCG lymphadenitis is a potential complication that necessitates an early recognition and implementing appropriate treatment protocols. Complete healing of suppurative lymphadenitis after BCG vaccine can be achieved using different treatment protocols.

Cytomorphology of palpable breast lesions: Diagnostic utility of FNAC in a developing country.

Breast lesions including breast cancer represent a major public health issue in Sudan. Fine-needle aspiration cytology (FNAC) is an established, simple, highly accurate, minimally invasive, and cost-effective method of diagnosing most breast lesions. The aim of this study is to document the most common breast conditions diagnosed by means of FNAC over a two-year period in Atbara, a city in north Sudan. A retrospective, descriptive, cross-sectional, laboratory-based study in which records of all palpable breast lesions diagnosed by FNAC in the years 2012 and 2013 were reviewed and analyzed. The total number of cases studied was 232; most subjects, 222 (95.7%), were females. The age range was 15-90 years (mean 38.2). Painless lump was the most common 190 (81.9%) clinical presentation. The left breast was affected more often than the right breast, 56.0% vs. 40.5%. Benign conditions were 167 (72%). Malignant neoplasms were 65 (28.0%). The most important associations with malignancy were female sex, age above 35 years, multiparity, painless lump at upper outer quadrant of left breast, lump size above 2 cm and the presence of an enlarged ipsilateral axillary lymph node at presentation. In the northern part of Sudan, the prevalence of malignant breast lesions diagnosed by FNAC is more than one fourth of all cases presenting with palpable breast lumps. FNAC is a technique that is ideal for use in resource-limited health settings.

Evaluation of breast disease by clinical breast examination (CBE): Experience of a tertiary care hospital

Introduction: Breast cancer is the second most common cancer (10.4 % of all cancer incidence, both sexes counted) and the fifth most common cause of cancer death in the world. In 2005, breast cancer caused 502,000 deaths worldwide. Clinical evaluation could function as a valuable diagnostic tool. Clinical evaluation, however, is a simple method to detect cases as it is inexpensive and non-invasive and if found to be accurate, might be of great value.Aim: To evaluate patients referred to colposcopy clinic in BSMMU for breast symptoms by clinical breast examination (CBE).Material and method: The study design was cross sectional study done in the colposcopy clinic in the department of Obstetrics and Gynaecology, under the ‘Establishment of National centre for cervical and breast cancer screening and training at BSMMU’ and ‘Cervical and breast cancer screening and training in BSMMU’ projects.Result: A total of 752 patients fulfilled the inclusion criteria , demographic features are demonstrated in mean age of the patients was 35.1±9.2 years, mean BMI was 22.5±2.1, about 30% subjects were postmenopausal and about 2% patients had history of breast cancer. Presenting complaint was a self-detected breast mass and found to have a mass on examination by her physician in 204 patients. 308 subjects complained of mastalgia; 34 patients complained of nipple discharge. Only 5 patients complained of axillary lymph node enlargement. Nipple abnormalities like retracted and cracked nipple was complained by 4% cases. Most patients (58%) were found to have normal findings. Palpable mass was found in 121 cases and bilateral in one case. Nipple abnormalities found in 10 cases. Tenderness and nipple discharge found in 15% and 4% cases respectively. Regarding the characteristics of the masses proved by cytology (FNAC), 109 were benign and 12 were malignant.Conclusion: CBE is an important screening procedure to identify breast pathology. Out of 752 patients breast pathology were identified in about 41% of patients and 10% breast lumps were malignant. So CBE should be done every three yearly in <40 and yearly in above 40 years women.J. Paediatr. Surg. Bangladesh 5(1): 20-24, 2014 (January)

Right axillary lymph node metastasis of carcinoma of the cecum with histologically proven cutaneous lymphatic invasion by carcinoma cells: a case report.

Axillary lymph node metastasis from colorectal carcinoma is extremely rare, and this scarcity hinders understanding of its pathogenesis and, thus, the application of appropriate management. Here, we present a case with axillary lymph node metastasis of cecal carcinoma associated with macroscopic invasion of the skin of the abdominal wall with histological evidence of such invasion, findings which support our hypothesis that the axillary lymph node metastasis developed via the lymph channels in the skin of the abdominal wall. A 76-year-old woman with cecal carcinoma (T4N1M0), complicated with an abdominal wall abscess, underwent right hemicolectomy with partial resection of the abdominal wall. Histology demonstrated multiple sites of lymphatic invasion in the skin. Two months later, an enlarged right axillary lymph node was noticed on CT, and an excisional biopsy was obtained, which later confirmed metastatic adenocarcinoma. This is the first case report of axillary lymph node metastasis of carcinoma of the cecum with histologically proven invasion via the lymphatic system in the skin. If axillary lymph node metastasis results from aberrant lymphatics due to invasion from an adjacent organ, and not the result of systemic malignant disease, it may be considered as a surgically curable pathology. Therefore, the authors advocate that patients with axillary lymph node metastasis should be evaluated with regard to the possibility of surgical curability.

Abstract P3-11-14: Is pathologic complete response (pCR) a valid marker of outcome even in large breast cancer? Clinical results from a neoadjuvant trial using a combination of epirubicin, docetaxel and bevacizumab (PROMIX)

Abstract Background: Several randomized trials have proven that preoperative chemotherapy is equivalent to adjuvant treatment, and allows for clinical and radiological assessment of efficacy in vivo. Recent results show that response-guided neoadjuvant therapy is a favorable policy for hormone receptor positive tumors, while pCR predicts prognosis for triple-negative (TNBC) and HER2 positive breast cancer (von Minckwitz 2013; Cortazar 2014). Since 2012 the FDA accepts pCR (ypT0 ypN0) as endpoint for accelerated drug approval. Methods: In total, 150 women 18 years or older with verified HER2 negative breast cancer suitable for primary medical treatment were included in the trial between September 2008 and December 2011. The patients received two courses of epirubicin and docetaxel (Taxotere®), both 75mg/m2 for the 1st two courses, followed by the same treatment with addition of bevacizumab (Avastin®) 15 mg/kg for 4 additional courses. Clinical and radiological evaluations with mammography and ultrasound were performed before start and after courses 2, 4 and 6. Core biopsies were taken before start, after 2 courses, and at time of surgery. Blood samples were drawn before and 24 hours after the first 4 courses. Results: Median age was 49 years, range: 27 to 70 years; 73% were reported as ductal, 15% as lobular, and 12% as rare histological types. Mean tumor size was 59 mm, median 55 mm, range: 20-180 mm; 3 tumors (2.0%) were reported as inflammatory, and 13 (8.7%) presented with skin involvement (T4b). Enlarged axillary nodes were found in 102 patients (68%) before start of treatment, 77 of these (64%) verified as metastatic. SNB in cases of normal axillary status was performed in 16 cases, in 9 cases (8%) with positive finding. Supra- or infraclavicular node involvement was verified in 20 cases (13%). 25% of all tumors were ER- and/or PR-negative, tumor grade based on a diagnostic biopsy was evaluable in only 83 cases. Of these, 4 (5%) were grade I, 46 (55%) grade II, and 33 (40%) grade III. Mean proliferation count (Ki67) was 37%, median 30%, range 1-90%. Breakdown into intrinsic subtypes based on immunohistochemistry defined 68 (46%) as luminal A-like, 36 (24%) as luminal B-like, and 44 (30%) as TNBC. pCR was achieved in 20 cases, 3 (2%) luminal A-like, 5 (3.4%) luminal B-like and 12 (8.2%) TNBC. After 2.2 years of follow-up, 35 patients (23.3%) have experienced recurrence and 18 of these (12%) have deceased due to breast cancer, among these 6 despite pCR, 2 classified as luminal B-like, and 4 as TNBC. The molecular subtype of the tumor predicted outcome, but pCR was not in our material, even after adjustment for tumor size at diagnosis, a predictor of favorable outcome. The number of events in relation to molecular subtypes is however limited. Updated outcome data will be presented. Conclusions: The present trial does not confirm previously reported observations that pCR is a marker of favorable prognosis. One possible explanation is that unfavorable biological characteristics, particularly heterogeneity, may increase with tumor burden. Genomic and proteomic analyses are currently ongoing. Citation Format: Thomas Hatschek, Judith Bjöhle, Elisabet Lidbrink, Tobias Lekberg, Niklas Loman, Anna von Wachenfeldt Väppling, Martin Söderberg, Zakaria Einbeigi, Lena Carlsson, Henrik Lindman, Irma Fredriksson, Jan Frisell, Lars Löfgren, Lisa Rydén, Mats Hellström, Mårten Fernö, Jonas Bergh. Is pathologic complete response (pCR) a valid marker of outcome even in large breast cancer? Clinical results from a neoadjuvant trial using a combination of epirubicin, docetaxel and bevacizumab (PROMIX) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-11-14.

STAT3 Signaling Hypersensitivity in a Child with Unicentric Castleman's Disease

10yo boy with enlarged right axillary lymph nodes (LN) was diagnosed with Unicentric Castleman’s Disease (UCD) after resection revealed hyaline vascular type. UCD is a rare, isolated lymphoproliferative disorder with poorly understood pathogenesis that has been linked to excessive release of IL6. In this study we phenotype the patient’s Tregs, Th1, Th2, Th17 and STAT3 response to cytokines. PBMCs (patient and three controls) and cells from patient’s resected LN (collagenase-digested) were analyzed by flow cytometry for intracellular Foxp3, cytokines, and p-STAT3. BD PhosFlow method was used to detect p-STAT3 after 30min stimulation: 10ng/mL IL6, IL9, IL21 or IFNa2. Lymphocyte subsets and serum cytokines performed by ARUP Laboratories were remarkable for elevated soluble CD25 (1136pg/mL, ref<1033) and IL13 (13pg/mL, ref<6). Patient’s CD4+PBMC: 5.8% Foxp3+Tregs, 4.6% IFNg+, 0.5% IL17A+, 31.2% TNFa+, 2.5% IL2+, 0.8% IL13+ and 1% IL4+. LN: 0.4% CD16+NK, 0.2% CD16+NKT, 72% CD19+, 16% CD4+ and 5% CD8+. CD4+LN: 21% Tregs, 10.7% IFNg+, 0.8% IL17A+, 8.4% TNFa+, 1.4% IL2+, 0.1% IL13+ and 0.4% IL4+. PBMC: %p-STAT3 MFI change from controls with IL6, IL9, IL21, IFNa2, respectively: monocytes (51, 0, 0, 22%), CD4+ (30, 0, 24, 29%), and CD56+NK (0, 16, 83, 40%). Expression of IL6 receptor was similar amongst patient and controls. The level of STAT3 hypersensitivity might be the underlying etiologic cause of the inflammatory response and lymphoproliferation within the lymph nodes. Genetic analysis is needed to investigate the possibility of a gain-of-function in STAT3.

Contralateral axillary silicone lymphadenopathy, following skin sparing mastectomy and immediate reconstruction with latissimus dorsi myocutaneous flap and implant

Sir, Dorogi et al. reported a case of contralateral axillary silicone lymphadenopathy after mastectomy, ipsilateral axillary clearance and immediate reconstruction with a Becker 25 expander implant. The authors commented the effect of axillary block dissection on lymphatic drainage pattern. More interestingly, silicone lymphadenopathy reported in this case was associated with an intra-capsular implant rupture only [1]. In our experience, we have also encounter a similar breast reconstruction case of contralateral axillary silicone lymphadenopathy, secondary to an intra-capsular implant rupture: a 69-year-old female underwent a right-sided mastectomy for ductal carcinoma in situ (DCIS) and immediate reconstruction with latissimus dorsi (LD) myocutaneous flap and a cohesive gel implant 14 years ago. Recently, she found a tender mobile lymph node in her left axilla and was referred promptly for further investigations. MRI scan suggested an intra-capsular implant rupture on the right and a reactive left axillary lymph node. Open biopsy of two enlarged left axillary lymph nodes (Fig. 1) confirmed the presence of numerous histiocytes containing foreign body type giant cells, which are appearances in keeping with a reaction to silicone. Patient subsequently underwent a right implant exchange, and the intra-capsular implant rupture was apparent intra-operatively. In our case, mastectomy was indicated for DCIS only, and therefore, ipsilateral axillary lymph nodes were not previously cleared. However, the significance of scarring from combined autologous and implant breast reconstruction has alternated the lymphatic drainage and later resulted in contralateral silicone lymphadenopathy, when an implant ruptured. As Dorogi et al. suggested, silicone leakage from ruptured breast implants has previously been reported; many of these cases were indicated for esthetic augmentation [2–4]. Very often, silicone leak remains localized and to ipsilateral axillary lymph nodes [2]. Patients who have had mastectomy and axillary lymph node dissection are thought to have disrupted or obstructed lymphatic drainage, and may therefore present recurrent pathology to alternate lymphatic pathways, such as the contralateral intramammary lymph nodes [5]. We have presented here an unusual case, which highlighted the consequence of scarring from combined

Tuberculous mastitis simulating carcinoma of the breast in a young Nigerian woman: a case report

Tuberculous mastitis is an uncommon disease even in countries where tuberculosis is highly endemic. It typically presents a diagnostic challenge masquerading as carcinoma or other primary disease of the breast. We report the case of a young multiparous Nigerian woman who presented with a tender left breast lump and enlargement of the left axillary lymph nodes for which a provisional diagnosis of carcinoma of the breast was made after clinical and radiological evaluation. The mass was pathologically diagnosed as tuberculous mastitis and anti-tuberculous therapy was instituted although she later absconded. This case shows that TM may present a diagnostic challenge on clinical, radiologic and microbiological investigation. Therefore, a high index of suspicion as well as FNAC and/or histological evaluation of tissue samples remain very important its diagnosis.

Use of Radioactive Seed to Localize Axillary Lymph Node in Breast Cancers

Introduction: Axillary lymph node biopsy in an irradiated or previously operated axilla can be technically challenging. Radio-labeled seed localized (RSL) biopsy is an emerging modality for localizing tissue of interest that is not amenable to wire localization. Case Report: A 60 year old female with history of breast cancer presented ten months after her initial resection with a new chest wall mass and an enlarged right axillary lymph node situated posterior and superior to the axillary vein. Given its location, wire localization was not possible and on the other hand operating without localization was too risky. We elected to place a 125I labeled titanium seed in the lymph node which greatly facilitated this otherwise difficult dissection and safely delivered the specimen needed for diagnostic purposes. Discussion: With the advancement of imaging technology, surgeons are able to safely and accurately recover diagnostic tissue specimen from extremely challenging anatomic spaces. Radio-labeled seed localization is another step in furthering surgical capabilities in this regard. RSL provides several advantages over wire localization: placement in lesions located deep in body cavities, seed placement can be scheduled a day prior to surgery thus making it more easier on patients, and no risk of cutting or dislodging the wire. Clinical practice points: The use of radio-labeled seed localized (RSL) breast biopsy is growing in popularity and is replacing wire localized breast biopsy. We present a case of a radioactive seed localized axillary lymph node resection that was not amenable to wire localization. Radioactive seed allowed precise localization of the node in a difficult anatomic location, thus facilitating successful resection of the node. Seed localization is a versatile approach for localizing lesions of interest and holds promise for not only breast surgery, but also for marking nodes or lesions of interest that are located deep in the abdominal or thoracic cavity.

Mondor's Disease of the Breast

A forty-six-year-old female presented with a history of left axillary pain, discomfort, chronic fatigue and palpitations. Clinical examination revealed large, tender nodules in the left axilla which were thought to represent enlarged axillary lymph nodes. Multiple dilated veins were visible in the left axillary region. The patient was diagnosed with Mondor’s disease based on the typical mammographic and ultrasound features.

Accurate diagnosis of axillary lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid.

Axillary lymph node enlargement following sentinel lymph node biopsy (SLNB) is often difficult to accurately diagnose. In keeping with the characteristically tortuous and aberrant pattern of tumor neovasculature, metastatic lymph nodes exhibit peripheral and mixed vascularity, resulting in a microvasculature that is often difficult to visualize. Contrast-enhanced ultrasonography (CEUS) with Sonazoid, a new generation contrast agent for ultrasonography, allows for the visualization of lymph node microvessels and may enable a more accurate evaluation of lymph node metastasis. This is a case report of axillary lymph node enlargement following SLNB, in which CEUS with Sonazoid resulted in an accurate diagnosis. On the basis of our experience with this case, we have initiated a clinical trial to evaluate the detection of lymph node metastasis through the use of CEUS in breast cancer patients.

Efficacy of lapatinib monotherapy on occult breast cancer presenting with cutaneous metastases: A case report.

The case of a 72-year-old female who identified a lymph node enlargement in the left axilla is reported in the present study. A lymph node biopsy revealed a metastatic adenocarcinoma of the axillary lymph node. Following various assessments, the patient was diagnosed with occult breast cancer and lymph node metastases, for which treatment was initiated. Trastuzumab monotherapy was administered as the patient was elderly, positive for the hepatitis B virus and exhibited the following immunostaining/immunohistochemical analysis results: Estrogen receptor (ER) negative (−), progesterone receptor (PgR) negative (−) and human epidermal growth factor receptor 2 (HER2) positive (3+). Breast ultrasonography was performed 10 months after the initial trastuzumab administration and the left axillary lymph node enlargement had reduced in size and severity. However, a skin rash (erythema) was observed encompassing the left breast and extending into the axilla. As determined by the result of a skin biopsy of this area, the patient was diagnosed with occult breast cancer with cutaneous metastases. The immunohistochemical analysis results obtained from the skin biopsy were similar to those obtained from the lymph nodes: ER (−), PgR (−) and HER2 (3+). Therefore, the patient was switched from trastuzumab to lapatinib monotherapy. The erythema completely disappeared after two months of treatment. At present (34 months following lapatinib monotherapy initiation) no new lesions or severe side-effects have been observed.

Management of idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment.

BackgroundIdiopathic granulomatous mastitis (IGM) is a rare inflammatory disease.Because of it’s uncommon etiology and rareness, diagnosis and treatment is still a challenge. Owing to wide spectrum of IGM it is difficult to standardize and optimize the treatment. The aim of this study was to report and describe the clinical signs, radiological findings, management, clinical course and the recurrence rate of the patients which were treated due to IGM.MethodsIn this retrospective review of patients diagnosed with IGM histopathologically between January 2006 and December 2011, medical reports, ultrasonography (US) and mammograhy (MMG) findings, follow-up information and recurrence were obtained from records.ResultsPainful, firm and ill defined mass was the symptom of all patients. While parenchymal heterogeneity, abscess and mass were the findings of US, increased asymmetric density was the main finding of MMG. Wide local excision was performed in 15 (62.5%) patients, incisional biopsy with abscess drainage was performed in 9 (37.5%) patients. Median follow-up was 34.8 (range 10–66) months.ConclusionsWhile the physical examination give rise to thought of breast carcinoma, the appearance of parenchymal heterogeneity and abscess formation on US especially with enlarged axillary lymph nodes support the presence of an inflammatory process. But these findings do not exclude carcinoma. Hereby, histopathologic confirmation is mandatory to ensure that a malignancy is not missed.

Synchronus Bilateral Breast Carcinoma (SBBC): A cytological diagnosis with review of literature

Introduction : A second primary breast cancer in the opposite breast can be either synchronous or metachronous. Bilateral synchronous breast cancer is defined as both cancers diagnosed within 3 months and neither can originate with metastasis from another tumour. Case Report : 40 year old female visited with complaint of mass in right breast and ulcer in left breast since 20 days with enlarged right axillary and left supraclavicular lymph nodes since last 2 months. Patient was referred for cytology of both lumps and lymphnodes. Cytological study of both lumps shown features of invasive duct carcinoma and lymph nodes shown metastatic deposits of carcinoma with similar morphological features as of breast lumps. Based on clinical presentation and cytological study case was diagnosed as synchronous invasive duct carcinoma. Conclusion : Synchronous breast cancer has poor prognosis hence early cytological and mammography detection helps in prompt management and thus decreasing morbidity as well as mortality.

Clinicopathological features and prognosis of metastases to the breast from extramammary solid tumors

To discuss the clinicopathological features and prognosis of metastases to the breast from extramammary solid tumors. The databases of Cancer Hospital of Chinese Academy of Medical Sciences from January 2001 to December 2012 were reviewed. 24 patients were identified with a diagnosis of metastasis to the breast from extramammary solid tumors and their clinical data were collected and analyzed. All the primary solid tumors and breast lesions were confirmed by pathology or cytology. Of the 24 patients, 22 were women and two were men. The median age was 54 years. The primary malignancies included non-small cell lung cancer (n = 10), small cell lung cancer (n = 4), rhabdomyosarcoma (n = 3), olfactory neuroblastoma (n = 3), ovarian cancer (n = 2), malignant melanoma (n = 1) and gastric cancer (n = 1). 15 patients (62.5%) complainted self-palpable breast nodules, two patients manifested as diffuse swollen and red of the whole breast, 7 patients (29.2%) were identified as well-defined nodules in the breast on CT images. The majority of metastases to breast presented as a solitary nodule with rapid growth, sometimes associated with axillary lymph node enlargement and occasionally with micro-calcification. Cytopathological examination could be used to differentiate the metastatic lesions from primary breast tumors. 83.3% (20/24) of the patients were concurrently accompanied with metastases in other organs and/or lymph nodes. The metastases to the breast from extramammy solid tumors were associated with a poor prognosis and the median overall survival was only 9.2 months. Metastasis to the breast should be considered in any patient with a known primary malignant tumor history who presents with a breast lump. Pathological examination should be performed to differentiate the primary breast cancer from metastatic tumor. An accurate diagnosis of breast metastases may not only avoid unnecessary breast resection, more importantly it is crucial to determine an appropriate and systemic treatment.

Intraductal papilloma in an axillary lymph node of a patient with human immunodeficiency virus: a case report and review of the literature

IntroductionInclusions of ectopic breast tissue in axillary lymph nodes are reported very infrequently and typically are only identified microscopically as an incidental finding. Furthermore the development of a benign proliferative lesion in the form of an intraductal papilloma from intranodal ectopic breast tissue is an extremely rare phenomenon with only three previous cases reported. This report describes an unusual and rare case of an intraductal papilloma arising in an axillary lymph node of a patient known to have the human immunodeficiency virus.Case presentationA 40-year-old Black African woman underwent excision of an enlarged palpable axillary lymph node. In the preceding 7 years she had received at least six separate surgical excisions to her ipsilateral breast for papillomatosis. The last surgical intervention was performed 1 year prior to presentation with an enlarged axillary lymph node. Histological examination of her axillary lymph node revealed a papillomatous proliferative epithelial lesion within an apparent encompassing duct, resembling a mammary intraductal papilloma. In the surrounding lymphoid tissue small groups of duct-like structures were additionally noted. Immunostaining with a panel of myoepithelial markers in conjunction with oestrogen receptor produced a mixed heterogeneous staining pattern in both the papillomatous lesion and the peripheral duct-like structures. This confirmed the diagnosis of a benign intraductal papilloma within an axillary lymph node, considered to have arisen from ectopic breast tissue.ConclusionsThis case demonstrates that intranodal ectopic breast tissue has the potential to undergo benign proliferative change albeit extremely rarely. Therefore this possibility must be considered to ensure the correct diagnosis is made. In addition, to the best of our knowledge, this is the first case report which has described recurrent intraductal papillomas and the subsequent development of an intraductal papilloma within an ipsilateral axillary lymph node, in a patient who is human immunodeficiency virus positive. There is minimal literature investigating the specific types of breast pathologies experienced by patients infected with human immunodeficiency virus and it remains unexplored as to whether human immunodeficiency virus may lead to proliferative papillomatous epithelial changes. This report considers the role of the human papillomavirus and recommends that further investigatory studies are required.

Index of Suspicion

The reader is encouraged to write possible diagnoses for each case before turning to the discussion. We invite readers to contribute case presentations and discussions. Please inquire first by contacting Dr. Deepak Kamat at DKamat@med.wayne.edu. A 2-year-old boy with a history of eczema and food allergies to nuts and soy presents to the emergency department with a 10-day history of generalized edema. The swelling began in the periorbital area but soon progressed to involve his entire body. There have been no fevers or any recent illnesses other than 1 day of cough and a few watery stools. He has had no new exposures to foods or other substances. His family history is remarkable for multiple allergies and eczema. Physical examination reveals a temperature of 98.8°F (37.1oC), heart rate of 98 beats per minute, respiratory rate of 36 breaths per minute, blood pressure of 103/65 mm Hg, and an oxygen saturation of 97% on room air. His weight is 12.6 kg (34th percentile). He is noted to have a moderate amount of periorbital edema, decreased breath sounds at the lung bases bilaterally, a protuberant abdomen, and 2+ pitting edema on his lower extremities. The rest of his physical examination findings are within normal limits. Laboratory evaluation reveals a white blood cell count of 23,800/μL (23.8 × 109/L), with 37% neutrophils, 49% lymphocytes, 4% bands, 7% monocytes, and 3% eosinophils; hemoglobin level of 13.3 g/dL (133 g/L); and platelet count of 427 × 103/μL (427 × 109/L). Serum electrolyte, blood urea nitrogen, and creatinine levels are normal. Sodium level is 132 mEq/L (132 mmol/L). Serum albumin level is 1.7 g/dL (17 g/L) (reference range, 3.4-5.4 g/dL [34-54 g/L]). Total protein level is 3.8 g/dL (38 g/L). Aspartate aminotransferase, alanine aminotransferase, and coagulation profiles …