Left Axilla Research Articles

Physiotherapy Rehabilitation in Subject with Scapular Osteochondroma: A Case Report

Introduction: The most prevalent benign tumour affecting the metaphysis of long bone is osteochondroma, a form of cartilaginous tumour. Solitary or multiple osteochondromas can prevail.Hereditary multiple exostosis (HME) or familial osteochondromatosis is the multiple variant, which is an autosomal dominant syndrome.
 Case Presentation: A 35-year old female with right-hand dominance was referred todepartment of physiotherapy. On palpation small nodular swelling of marble size was present in left axilla. X-rays findings showed increased scapular mass and ribs were compressed laterally.
 Discussion: The most widespread benign tumour is osteochondroma. In 3.0-6.4 percent of all instances, the scapula is implicated. The osteochondroma normally develops on the scapula's anterior aspect. The scapula osteochondroma induces pain and a grating sound when the scapula is moved. Mechanic irritation of muscle, tendon, or soft tissue, emergence of a pseudoaneurysm or bursa, fracture, or malignant transformation are all causes of symptoms.
 Conclusion: Osteochondroma is a common benign tumor. Management of osteochondroma is important to improve the quality of life. Physiotherapy plays an important role in managing Scapular osteochondroma.

ADULT-ONSET CYSTIC HYGROMA IN AXILLA: A RARE CASE REPORT FROM INDIA AND LITERATURE REVIEW

Background. Cystic hygroma (CH), occurs in 1/6000 live births and in 90% of cases develops in age less than 2 years old. They are mainly located in cervicofacial region. Adult-onset CH is very rare. Objective. The aim of this study is to review literature to discuss the clinical presentation, diagnosis, and treatment of CH in adults through a case report of unilocular CH in the axillary region in an adult male from India. Methods. A first case report of unilocular CH in axillary region in an adult male from India is being investigated. Results. Here we report a case of unilocular CH in the axillary region in a 49-year-old male with a 14x16x8 cm cystic swelling in left axilla with a history of aspiration failure. Contrast-enhanced MRI (CEMRI) showed well-defined thin walled, unilocular cystic lesion which appeared hyperintense on T2 & STIR and hypointense on T1W1 and showed thin peripheral rim of enhancement on post contrast images. The patient underwent surgical excision and the diagnosis of a pathological CH was established. His postoperative recovery was uneventful and had no evidence of recurrence. Conclusion. Due to rarity of adult-onset unilocular CH in axilla, its evaluation for prompt diagnosis and definitive treatment to prevent recurrence and complications is urgent. Furthermore, this is the first reported case from India which has been successfully managed at a peripheral hospital in Northeast-India and our report of this case contributes to the evidences supporting the role of CH in a differential diagnosis for masses in the adult axilla, especially in acute phase with no predisposing factors.

A Huge Benign Phyllodes Tumor in 37 Year Old / Middle Aged Woman: A Case Report

Phyllodes tumor is uncommon benign tumor of breast with a risk of malignant transformassion. Malignant phylloies tumors originates from the connective tissue of the breast therefore these tomors are sarcomas on histology. A 37 years old married woman presented with painless slowly progressive enlargement of right breast for two years duration. On physical examination confirmed the presence of a large size lobulated well defined mass lesion in occupying in UIQ, UOQ & LOQ of right breast. Ultrasonography of breast and Mammography revealed mass lesion. FNAC from the lesion & subsequently histopathology confirmed the diagnosis of benign phyllodes tumor of breast. Overlying skin was normal. There was no discharge from the nipple. No lymph nodes were palpable in right axilla. Left breast and left axilla were unremarkable. Her systemic examination was normal. The present case report describes a case of begin phyllodes tumor of breast in a 37-year-old female and its clinical, ultrasonographic, cytological and histopathological correlation.

Leiomyosarcoma of the Axillary Vein

<h3>Introduction and Objective</h3> Leiomyosarcomas (LMS) are the most common malignancies affecting the vasculature with typical origin from the venous system. Extremity LMS are not commonly encountered, with a majority arising from the femoral vein, and upper extremity LMS are extremely rare. Primary soft tissue sarcomas most commonly occur in the axilla, which is also the site of distant metastasis. The brachial plexus can be involved in axillary tumors causing loss of function to the extremity with the ulnar nerve being most commonly involved. Herein, we report a rare primary vascular LMS of the upper extremity involving the axillary vein. <h3>Case Report</h3> This is a case of 61-year-old male with a complex oncological history. He was previously diagnosed with left renal cell carcinoma managed with a partial nephrectomy 5 years prior to presentation. The patient was then diagnosed with locally advanced oropharyngeal squamous cell carcinoma discovered during workup for severe headache and sore throat. As part of his staging, a Positron Emission Tomography–Computed Tomography (PET-CT) was performed and showed an avid soft tissue density in the left axilla concerning for possible lymphadenopathy. A core needle biopsy was suggestive of leiomyoma. The mass grew to 3cm and became symptomatic with associated swelling and pain radiating to the hand. MRI showed a well circumscribed mass of the left axilla with partial compression of the axillary vein without evidence of circumferential encasement of the neurovascular bundle. Left axillary exploration was done with intraoperative findings of an ovoid mass arising from the wall of the axillary vein at the junction with the brachial vein. The axillary vein was mobilized and a 5cm segment was resected en bloc with the mass. The vein was primarily reconstructed in an end-to-end fashion. Pathological evaluation confirmed the diagnosis of high grade vascular leiomyosarcoma with negative but close margins. The patient underwent further management with adjuvant radiation. Given his oncologic history, he underwent an evaluation for Hereditary Leiomyomatosis and Renal Cell Carcinoma (HLRCC) which was negative. On follow up two months later, he had complete resolution of pain in his left arm with intact motor and sensory function. <h3>Discussion</h3> The largest case series of vascular leiomyosarcoma included 86 patients with most of them arising from the inferior vena cava. Reports of extremity vein LMS are typically in case reports and case series. Axillary vein LMS is extremely rare. Vascular LMS have more aggressive presentations and delayed recognition along with earlier metastasis as compared to cutaneous LMS. The definite management is resection with adjuvant chemoradiation therapy. Limb loss can typically be avoided unless the patient presents late. Reconstruction of the vein with graft is associated with higher risk of thrombosis without improved outcomes and has generally been avoided in the reported literature.

EP.TH.515A Case of mucinous adenocarcinoma of the breast in a young male patient presenting with a subcutaneous axillary lump

Abstract Aims Mucinous adenocarcinoma of the breast is rarely encountered clinically, and makes up only 0.01% of Breast cancer (BC) cases and &amp;lt; 1% of male breast cancer (MBC). We describe an extremely rare case of mucinous carcinoma in accessory axillary breast tissue in a male. Case details A 48-year old male presented with a subcutaneous lump in his left axilla. Ultrasound described a 30mm hypoechoic mass and core biopsy confirmed mucinous adenocarcinoma, strongly positive for oestrogen and progesterone receptors, HER2 negative. A solitary enlarged axillary node in was sampled (C2) and mammogram reported a 32mm spiculate mass (M4) on the left. PET scan showed uptake only in the known axillary mass. Management Wide Local Excision and Sentinel Lymph Node Biopsy (SLNB) was completed. Histology showed a 27 mm grade 2 mucinous carcinoma, and the patient completed adjuvant radiotherapy and was commenced on tamoxifen. Conclusions MBC is rare, and accounts for only 1% of all BC. Men tend to be diagnosed at an older age (mean is 67 years) and usually have genetic/hormonal risk factors. Histologically, invasive ductal carcinoma makes up 95% of MBC. In every regard therefore, our case breaks the mold since, he was young, had no genetic/family history and no background of gynaecomastia (present in 6-38%). Literature review suggests that this is only the second case of its kind and from it we can learn to be vigilant for MBC in accessory axillary breast tissue as well as the more typical presentations.

Elevated magnetic resonance imaging measures of adipose tissue deposition in women with breast cancer treatment-related lymphedema.

Breast cancer treatment-related lymphedema (BCRL) is a common co-morbidity of breast cancer therapies, yet factors that contribute to BCRL progression remain incompletely characterized. We investigated whether magnetic resonance imaging (MRI) measures of subcutaneous adipose tissue were uniquely elevated in women with BCRL. MRI at 3.0T of upper extremity and torso anatomy, fat and muscle tissue composition, and T2 relaxometry were applied in left and right axillae of healthy control (n = 24) and symptomatic BCRL (n = 22) participants to test the primary hypothesis that fat-to-muscle volume fraction is elevated in symptomatic BCRL relative to healthy participants, and the secondary hypothesis that fat-to-muscle volume fraction is correlated with MR relaxometry of affected tissues and BCRL stage (significance criterion: two-sided p < 0.05). Fat-to-muscle volume fraction in healthy participants was symmetric in the right and left sides (p = 0.51); in BCRL participants matched for age, sex, and BMI, fat-to-muscle volume fraction was elevated on the affected side (fraction = 0.732 ± 0.184) versus right and left side in controls (fraction = 0.545 ± 0.221, p < 0.001). Fat-to-muscle volume fraction directly correlated with muscle T2 (p = 0.046) and increased with increasing level of BCRL stage (p = 0.041). Adiposity quantified by MRI is elevated in the affected upper extremity of women with BCRL and may provide a surrogate marker of condition onset or severity. NCT02611557.

Axillary lymph nodes on PET in Hodgkin lymphoma after COVID-19 vaccination.

A 21-year-old woman presented with nodular sclerosis Hodgkin lymphoma stage IIIA, IPS 2 with a baseline 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) showing initial involved lymph nodes in both sides of the neck, left axilla, mediastinum, hili, para-aortic, left iliac, and involvement of the spleen. After one course of BrAVD (brentuximab-vedotin, adriamycine, vinblastine, dacarbazine), the interim FDG PET/CT scan was negative, classified as a complete metabolic response. A third FDG PET/CT scan was performed after completion of her chemotherapy consisting of six courses of BrAVD. This scan showed a reappearance of FDG avid lymph nodes, with a Deauville score of 5, in the original sites in the left axilla and neck. The most FDG avid lymph node was excised and revealed florid follicular hyperplasia instead of recurrence of Hodgkin lymphoma. In hindsight, she received a COVID-19 vaccination in her left arm several weeks prior to the last FDG PET/CT scan. In the meantime, various articles were published that relate the occurrence of FDG avid ipsilateral axillary and neck lymph nodes to COVID-19 vaccination of several manufacturers. We, therefore, concluded all FDG avid lymph nodes to be triggered by the vaccination. FDG PET/CT scan is valuable in steering therapy in Hodgkin lymphoma patients. However, enhanced FDG uptake only indicates that enhanced glucose metabolism and false positive results are possible, necessitating good clinical correlation. Documentation of the vaccination status including date(s), side, and manufacturer is of importance. In cancer patients, the side and timing of the vaccination should be discussed with the patient to prevent concern of recurrence and avoid unnecessary diagnostics and as in our case.

An Iron Rod Impaling the Axilla with Major Vascular Injury: a Case Report

Background and Objective Impalement injury is an uncommon cause of vascular trauma; however such spectacular injuries are associated with a high mortality rate and need to be managed by a multidisciplinary medical team at tertiary trauma center. The reported literature is scarce and no available well-written guidelines so that the management plan should be individualized and tailored to the situation at hand. The objective of this case study is to update our experience and protocols to maximize the clinical outcome and minimize the fatality rate of such challenging life-threatening events. Methods It is a case report of a 31-year construction worker that sustained an impalement injury when he fell down on an iron rod traversing his left axilla; he was transferred to our hospital with a 90- cm rod in situ. The patient was rapidly resuscitated and investigated preparing him for prompt surgical intervention; the metallic rod was extracted at the theater gently under direct vision with gushing out of blood due to the major vascular injury that was immediately controlled, followed by proper washout and thorough debridement of all devitalized tissues. Then, exploration of the neurovascular bundle at the axilla showed an injury of the axillary vein for which primary repair was successfully performed, but fortunately the axillary artery and brachial plexus were intact. Results: The patient had uneventful postoperative course with no complications and his limb was saved; he is being followed for 14 months up till now. Conclusion Major vascular injuries caused by impalement accidents are rare events; however they are challenging and may be fatal. Our current conclusions and recommendations are deficient and we need more updated research work to improve the outcome and decrease the number of deaths. We can acknowledge the end points which include careful and rapid transportation of the patient to a tertiary trauma centre with the impaled objects in situ that should be extracted only at the theater, proper diagnosis and prompt surgical intervention by a multidisciplinary team.

Acute toxoplasmosis mimicking metastatic lymphadenopathy of sarcoma

Abstract Introduction: Clear cell sarcoma is a rare malignant neoplasm with the potential to metastasize to lymph nodes. We report herein a case of acute toxoplasmosis that mimicked metastatic lymphadenopathy from treated clear cell sarcoma on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Toxoplasmosis is usually asymptomatic in immunocompetent hosts. Acute acquired toxoplasmosis clinically manifests as lymphadenopathy predominantly involving the cervical nodes. Patient concerns: A 45-year-old woman underwent resection of subcutaneous clear cell sarcoma of the right knee. PET/CT performed four years after surgery revealed multiple sites of lymphadenopathy with avid FDG uptake in the right neck, left axilla, left pulmonary hilum, and right inguinal regions. The patient was afebrile and asymptomatic. Metastases were suspected and excisional biopsy of a left axillary node was performed. Diagnoses: Histopathological examination revealed reactive lymphadenitis, suggesting toxoplasmic infection without evidence of malignancy. Serum levels of toxoplasmic immunoglobulin (Ig)M antibodies were high. Serum IgG antibodies were significantly elevated in six weeks from the PET/CT examination. The patient had a cat at home, which could have represented the source of infection. Interventions: The patient was carefully monitored using regular imaging examinations. Outcomes: FDG accumulations resolved spontaneously on follow-up examination one year later. Conclusion: We report a case in which toxoplasmic lymphadenitis mimicked malignant lymphadenopathy. Lymphadenopathy at a distant site from the primary malignancy with FDG avidity may be due to infectious or inflammatory conditions, creating false-positive results.

Invasive micropapillary carcinoma: a rare and aggressive breast cancer

Invasive micropapillary carcinoma of the breast is a rare and distinct histological variant of breast cancers, accounting for less than 3% of all breast carcinomas. It is characterized by a pejorative prognosis due to heavy lymph node involvement and the presence of numerous vascular and lymphatic emboli. We here report the case of a 63-year-old woman presenting with left mastodynia evolving for two months. Physical examination revealed breast asymmetry with skin retraction and multiple suspected lymph nodes in the left axilla. Mammography objectified a spiculated mass in the left breast classified as ACR5. Breast microbiopsy showed invasive micropapillary carcinoma. The patient underwent left Patey’s mastectomy with ipsilateral axillary dissection. Macroscopically, the tumor was grayish-white with spiculated margins located at the union of the two external quadrants and measuring 13 x 8 cm (Panel A). Histological examination of the surgical specimen revealed invasive carcinomatous proliferation arranged in clusters, nests, micropapillae, morules and glands with reversed polarity within a fibro-inflammatory stroma retracted around the carcinomatous structures (Panel B, C). Histoprognostic grading (SBR grade) modified according to ELSTON and ELLIS was 3. Several peritumoral vascular emboli were detected as well as lymph nodes metastases 20N+/20N. Immunohistochemistry using EMA showed reversed polarity (Figure D). Molecular classification of the tumor was luminal B. The postoperative course was simple. The patient underwent adjuvant chemoradiotherapy. Currently, the patient is systematically monitored on an outpatient basis.

Sarcoid-like reaction in a HER2-positive breast cancer patient: A case report.

Introduction and importanceSarcoid-like reaction is a systemic granulomatous reaction that may develop in the lymph nodes and organs of cancer patients. Distinguishing a sarcoid-like reaction from metastasis is difficult. Accurate diagnosis of this reaction is key to preventing overtreatment.Case presentationA 51-year-old woman presented with a lump in her left breast and swollen lymph nodes in her left axilla and infraclavicular fossa. A core biopsy was performed, leading to the diagnosis of grade 2 infiltrating ductal carcinoma, clinical stage T2N3M0 with estrogen and progesterone receptor negativity and human epidermal growth factor receptor-2 positivity. After neoadjuvant therapy, the tumor in her left breast reduced in size, but the lymph nodes remained swollen. Mastectomy and axillary lymph node dissections were performed. In the pathological findings, epithelioid cell granuloma was observed in the lymph nodes. Based on these findings, lymph node swelling was attributed to a sarcoid-like reaction.Clinical discussionSLRs have been reported in 4–14% of cancer patients. Although there are various imaging modalities for detecting swollen lymph nodes, the differential diagnosis of cancer metastasis is often difficult.ConclusionHistological evaluation of swollen lymph nodes is required to prevent overtreatment; especially in cases where the tumor size is reduced by chemotherapy, but the lymph nodes remain swollen.

The Efficacy of Physical Therapy Rehabilitation Program for Women Following a Modified Radical Mastectomy: A Case Report

Background: The most commonly identified cancer is breast cancer. In either the lobules or the breast ducts, the cancer normally grows. Infiltrating ductal carcinoma is the most common subtype. It may appear as a lump or mass; changes in the skin or nipple; breast rash or redness; or lymphadenopathy.&#x0D; Presenting Complains and Investigations: the patient presented with the complains of swelling and pain in the left breast in lower outer quadrant since 6 months, which was initially small in size and gradually increased and reached up this level 2x2 cm which placed in infra areolar region covering lower inner and outer quadrant. USG and cytology reports showed bilateral breast with axilla. Right breast was normal, enlarged lymph node in the right axilla measuring 15.2 x 4.6 mm with maintained hilum S/O reactive lymphadenopathy. In left breast there is E/O ill-defined taller than wider irregular hypoechoic lesion with spiculated margins, measuring approximately 15.9 x 12.4 mm in lower inner quadrant containing multiple foci of calcification within showing central vascularity OB doppler on elastography lesion is stiff, in left axilla there is E/O on enlarged USG lymph node present measuring 10.2 x 6.7 mm with maintained hilum S/O reactive lymphadenopathy. Impression of F/S/O malignant lesion in the left breast lymphadenopathy.&#x0D; Diagnosis: Left sided infiltrating ductal carcinoma.&#x0D; Therapeutic Intervention and Outcomes: Physical therapy intervention involved a variety of range of motion exercises, strengthening exercises, resistance conditioning, breathing exercises, lymphoedema treatment and scar management. This intensive outpatient program is a successful way to enhance the mobility of the shoulder and ROM during the initial 6-week treatment cycle after surgery. Shoulder range of motion was increased, patient was able to do basic activities of daily living like dressing, bathing, combing, etc. Edema was reduced.&#x0D; Conclusion: Shoulder stiffness after modified radical mastectomy is the commonest complication. Upper limb mobility exercises reduced the shoulder stiffness. Breathing exercises improved the respiration. Strengthening and general aerobic exercises helped the patient to get back on her normal routine.

The Iceman : Life scenarios and pathological findings from 30years of research on the glacier mummy "Ötzi"

The comprehensive investigation of the excellently preserved mummy of Ötzi, the Iceman, and his equipment over the last 30years has provided a wealth of information about the life and disease of this late Neolithic individual. This research has indicated that his origin was from alocal southern Alpine population, that he grew up in the valleys of the Southern Alps, and that he had considerable local mobility. He had well-balanced nutrition with amixed vegetable and animal diet. He was very mobile in the alpine terrain and of athletic constitution. The Iceman suffered from mild to moderate degenerative joint disease primarily of the right hip joint, slight spondylosis of the cervical and lumbar spine, aminor focal (premature) arteriosclerosis, lung anthracosis and possibly silicosis, previous pleuritic inflammation (possibly of post-specific origin), intestinal infections of the stomach by Helicobacter pylori and Trichuris trichiura worm infestation in the intestines, amild osteomalacia of cancellous bone, and diverse pathologies of his teeth with dental caries and periodontitis, as well as hair anomalies. The presence of borreliosis is still under debate. As potential remedies, the Iceman carried some anthelmintic substances with him: abirch polypore and an anthelmintic fern. The numerous tattoos may also have had therapeutic effects. Finally, the last days of Ötzi could be reconstructed quite precisely: his gastrointestinal content indicates that the Iceman moved from Alpine heights to a lower location and then again up to the glacier region where he died. During this journey he encountered two attacks: the first, several days before his death, lead to astabbing wound in his right hand; the second was an arrow hit that wounded the Iceman lethally at his left axilla by laceration of the subclavian artery.

What Can Proton Beam Therapy Achieve for Patients with Pectus Excavatum Requiring Left Breast, Axilla and Internal Mammary Nodal Radiotherapy?

AimsExposure of the heart to radiation increases the risk of ischaemic heart disease, proportionate to the mean heart dose (MHD). Radiotherapy techniques including proton beam therapy (PBT) can reduce MHD. The aims of this study were to quantify the MHD reduction achievable by PBT compared with volumetric modulated arc therapy in breath hold (VMAT-BH) in patients with pectus excavatum (PEx), to identify an anatomical metric from a computed tomography scan that might indicate which patients will achieve the greatest MHD reductions from PBT. Materials and methodsSixteen patients with PEx (Haller Index ≥2.7) were identified from radiotherapy planning computed tomography images. Left breast/chest wall, axilla (I–IV) and internal mammary node (IMN) volumes were delineated. VMAT and PBT plans were prepared, all satisfying target coverage constraints. Signed-rank comparisons of techniques were undertaken for the mean dose to the heart, ipsilateral lung and contralateral breast. Spearman's rho correlations were calculated for anatomical metrics against MHD reduction achieved by PBT. ResultsThe mean MHD for VMAT-BH plans was 4.1 Gy compared with 0.7 Gy for PBT plans. PBT reduced MHD by an average of 3.4 Gy (range 2.8–4.4 Gy) compared with VMAT-BH (P < 0.001). PBT significantly reduced the mean dose to the ipsilateral lung (4.7 Gy, P < 0.001) and contralateral breast (2.7 Gy, P < 0.001). The distance (mm) at the most inferomedial extent of IMN volume (IMN to heart distance) negatively correlated with MHD reduction achieved by PBT (Spearman's rho –0.88 (95% confidence interval –0.96 to –0.67, P < 0.001)). ConclusionFor patients with PEx requiring left-sided breast and IMN radiotherapy, a clinically significant MHD reduction is achievable using PBT, compared with the optimal photon technique (VMAT-BH). This is a patient group in whom PBT could have the greatest benefit.

Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Hodgkin's Lymphoma: Diagnostic Challenge during COVID Vaccination.

Benign metabolic uptake on fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) is not uncommonly seen after immunization. We report a case of 30-year-old man with Hodgkin's lymphoma who underwent two cycles of chemotherapy. Interim 18F-FDG PET/computed tomography demonstrated complete metabolic response of prior hypermetabolic bilateral supraclavicular and mediastinal lymph nodes. Although multiple new normal-sized hypermetabolic left axillary and subpectoral lymph nodes are noted, relevant history revealed COVID vaccine 7 days prior scan with mild FDG uptake at the left deltoid muscle. These new findings at the left axilla are likely related to recent vaccination. 18F-FDG PET uptake in the lymph nodes is not so uncommon after immunization; relevant history is very important especially in the phase of massive immunization to avoid false interpretation.

Unexplained Fatigue in an Otherwise Healthy Man Linked to Kikuchi-Fujimoto Disease, A Case Report

Kikuchi histiocytic necrotizing lymphadenitis is a benign and self-limited illness usually characterized by cervical lymphadenopathy and fever. We present a case of a 42-year male who complained of extreme fatigue for 2 weeks. On laboratory workup, he had leucopenia and thrombocytopenia with normal peripheral blood and bone marrow examination. The radiological investigation revealed multiple enlarged lymph nodes in the left axilla and left supraclavicular region. The subsequent excisional biopsy of the axillary node clinched the diagnosis of Kikuchi- Fujimoto disease. The patient was completely recovered and laboratory parameters were normal with supportive treatment. Kikuchi- Fujimoto disease should be considered in patients with unexplained fatigue with lymphadenopathy and early biopsy prevents unnecessary investigations as well as potentially harmful treatments.

Idiopathic Multicentric Castleman Disease

Castleman Disease (CD) is a spectrum of heterogenous hematological diseases that share characteristic clinical, histopathological, and immunological features. We present a case of a 61-y female with history of non-Hodgkin Lymphoma and hypothyroidism presenting with fatigue, generalized weakness, nausea, and poor appetite. On admission, physical examination was unremarkable, and labs were notable for hyperkalemia, hyperuricemia and worsening renal function. Imaging showed lymphadenopathy in neck, mediastinum, and left axilla along with mediastinal and retroperitoneal lymphadenopathy. Initial work up of serum electrophoresis was suggestive of multiple myeloma however bone scan did not reveal any lytic lesions. As biopsy results were pending, patient developed worsening cytopenia’s and a repeat serum electrophoresis showed a M spike with IgG lambda against a polyclonal background. Bone marrow biopsy showed polytypic plasmacytosis that was negative for HHV 8 and lymph node biopsy also showed polytypic plasmacytosis. Further work confirmed the diagnosis of idiopathic multicentric Castleman disease and patient was treated with silutuximab and responded well.

Coronavirus disease 2019 vaccine mimics lymph node metastases in patients undergoing skin cancer follow-up: A monocentre study

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic has changed the lives of people around the world. Fortunately, sufficient vaccines are now available. Local reactions with ipsilateral lymphadenopathy are among the most common side effects. We investigated the impact of lymphadenopathy after COVID-19 vaccination on the value of ultrasound in tumour patients. Patients and methodsPatients with melanoma or Merkel cell carcinoma were included who underwent lymph node excision and received COVID-19 vaccination within 6 weeks before surgery. The consistency of the preoperative ultrasound findings with the histopathologic findings was investigated. ResultsEight patients were included (two Merkel cell carcinoma and six melanoma patients) who underwent lymph node excision between 16th April 2021 and 19th May 2021 and had previously received COVID-19 vaccination. In three of the eight patients (one Merkel cell carcinoma and two melanoma patients), lymph node metastases were erroneously diagnosed preoperatively during tumour follow-up with physical examination, ultrasound, and or fluorodeoxyglucose (FDG)–positron emission tomography (PET)/computed tomography (CT). In these three patients, the suspected lymph node metastases were located in the left axilla after COVID-19 vaccination in the left upper arm, which resulted in selective lymph node removal in two patients and complete lymphadenectomy in one patient. ConclusionCOVID-19 vaccine–associated lymphadenopathy is expected to be observed much more frequently in the near future because of increasing vaccination rates. This cause of lymphadenopathy, which may in ultrasound as well as in FDG PET/CT resemble lymph node metastases, must be considered, especially in oncologic patients undergoing tumour follow-up. In addition, COVID-19 vaccination should be given as far away as possible from an underlying primary on the contralateral side to avoid oncologic misdiagnosis followed by malpractice.

A Case Report of Leptomeningeal Carcinomatosis Secondary to Recurrent Merkel Cell Carcinoma after Avelumab

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine cancer with a high mortality rate of 33% to 46%. Merkel cell is a type of epidermis cell receptor responsible for contact sensitivity and is known to have neuroendocrine properties. Treatment of Merkel cell carcinoma with avelumab has been prominsing, but its rarity and poor prognosis necessitates close follow up. A 71-year-old woman presented with a left forearm mass that was initially suspected to be a sebaceous cyst. After surgical excision and biopsy, she was diagnosed with Merkel cell carcinoma. The patient underwent avelumab treatment for 2 years, with remission of cancer for 24 months. A positron emission tomographic scan at 24 months of treatment noted uptake in the left axilla and portocaval regions. Despite receiving different combinations of immunotherapy, chemotherapy, and radiation, the patient's cancer metastasized to the leptomeninges. She was transitioned to hospice and passed away 3 months after diagnosis of leptomeningeal carcinoma. This case highlights the efficacy of avelumab in keeping patients in remission, which can offer increased quality of life. However, it also highlights the aggressive nature of Merkel cell carcinoma and the importance of surveillance for early detection of recurrence.

Pathological Changes in Axillary Hyperhidrosis and Axillary Osmidrosis Induced by Microwave Treatment: Comparison of Single‐ and Double‐Pass Irradiation

To analyze histopathological changes and degree of damage to the axillary tissue due to single- and double-pass irradiation therapy using a microwave energy-based device. STUDY DESIGN/MATERIALS ANDMETHODS: We included 15 axillary hyperhidrosis and axillary osmidrosis patients who received microwave irradiation therapy between March 2017 and March 2019. Ten patients underwent single-pass irradiation and five underwent double-pass irradiation, after which skin samples were collected from the right and left axillae for pathological analysis. Samples were taken in a consistent manner from Patient 6 onwards and a comparative study of five single-pass and five double-pass patients was conducted (n = 10). Histopathological analysis showed destruction and fibrosis in addition to necrosis and damage to the adipose tissue in apocrine and eccrine sweat glands. In the superficial microvasculature, blood vessel wall damage and thrombus formation were observed as well as damage in the hair follicles and hair bulbs. No obvious damage was observed in the epidermis and nerves. The amount of damage to sweat glands was higher in patients undergoing double-pass instead of single-pass irradiation. From a histopathological point of view, microwave energy-based irradiation therapy can be considered efficient, as there was no damage to epidermis and nerves and favorable destruction of apocrine and eccrine glands. As the amount of damaged sweat glands was higher after double-pass irradiation, it can be considered more effective than single-pass irradiation. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.