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A small axillary nodule—a therapeutic dilemma?
  1. A Mazumdara,
  2. R K Vasishtab,
  3. S M Bosec
  1. aPost Graduate Institute of Medical Education and Research, Chandigarh, India: Department of Surgery, bDepartment of Pathology, cSurgery Unit II and Emergency Services
  1. Professor S M Bose, H No 75, Sector 24, Chandigarh, 160023 India smbose>medinst{at}pgi.chd.nic.in or smbose{at}satyam.net.in

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Answers on p 135.

A 75 year, postmenopausal women presented with a lump in the left axilla associated with occasional pain for six months. There was no history suggestive of an increase in size, an awareness of a lump in either breast or the opposite axilla, or discharge from the nipple. Past medical history was not contributory as there was no family history of breast cancer. Examination showed a firm, mobile lump in the centre of left axilla (1× 1 cm), subcutaneous in location. No other lump could be detected in the axilla or either of the breasts.

The patient had been seen earlier by a general practitioner who considered the lump of benign pathology. Fine needle aspiration cytology (FNAC) carried out in our hospital revealed features suggestive of metastatic carcinoma. Excision biopsy showed it to be an infiltrating duct carcinoma. Chest radiography, ultrasonography of the abdomen, and bilateral mammography were normal.

The patient underwent total mastectomy and axillary clearance with excision of the axillary scar. Histopathology revealed no primary focus in the entire breast or lymph nodes in the axilla. Sections from the excised scar tissue showed a very small focus of malignancy (fig 1). The postoperative period was uneventful. An oestrogen receptor study was positive. The patient is followed up regularly and taking tamoxifen 20 mg once a day.

Figure 1

Microphotograph showing nest of tumour cells beneath the skin in the subcutaneous plane.

Questions

(1)
What is the significance of an axillary nodule in an elderly patient?
(2)
What should be the diagnostic modality in a case of axillary nodule?
(3)
What is the treatment modality in a case of axillary nodule with occult metastasis?
(4)
What are the various histopathological considerations in such a case?

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