Axillary Adenopathy - Unilateral / Chronic Lymphocytic Leukemia (CLL)
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This is a 59 year old female presenting for a screening mammogram.
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You'll notice right away that the screening mammogram I'm showing you is
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a 2D full field digital mammogram, not tomosynthesis. We've interpreted
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this mammogram as normal, which makes sense given lack of imaging findings,
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axilla looks okay. I wanna show you the patient presenting three years later
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for the same screening mammogram. And right away, you can see that the
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imaging appearance of the left axilla has changed. There's numerous large
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axillary lymph nodes projecting over that axillary tail, axilla region,
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which have appeared since the prior exam. Now of course, we don't see
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those on the screening exam. It's hard for us to image the axilla. I'm
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gonna pull down just the left MLO view so we can look at
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this tomo. Tomo findings won't be that specific, they'll again show us our
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large axillary lymph nodes with an overall oval appearance, circumscribed
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margin. Not surprisingly, we don't really see the
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high limb in these lymph nodes, and that's not uncommon, but of course
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these do look very rounded in comparison to more normal appearing lymph
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nodes. I'm gonna pull down her prior left MLO image
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just as a point of comparison, and you can see much more normal
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appearing lymph nodes in the left axilla. So these abnormal nodes have developed
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since that time. And of course, when we're looking at this case,
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we realize that this is unilateral axillary adenopathy. And the primary
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differential diagnosis for unilateral axillary adenopathy is of course malignancy.
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And usually an associated malignancy within the same breast.
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We don't see anything on this screening exam, and that may not be
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too surprising because sometimes we know that the sensitivity of mammography
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is not perfect, and we may not ever see anything on the screening
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exam. So this patient was recommended for further evaluation with axillary
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ultrasound. She underwent that axillary ultrasound, again demonstrated multiple
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large abnormal lymph nodes in the left axilla. One of these was subsequently
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biopsied, demonstrating CLL, chronic lymphocytic leukemia, lymphoma, and
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she went on to further treatment. Sometimes if we did see this abnormal
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nodes in the left axilla, and they were proven to be a metastatic
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breast cancer, and we didn't see anything on the mammogram, we would recommend
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an MRI for further evaluation to further evaluate any
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potential smaller malignancy in that ipsilateral breast, which might be
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contributing to this metastatic to be used in the axilla. But in this
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case, it was just CLL and the patient went on for further treatment.
Ryan W. Woods, MD, MPH
Assistant Professor of Radiology
University of Wisconsin School of Medicine and Public Health
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