53-year-old woman recalled for large left axillary lymph node
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So our first case is a 53-year-old woman recalled
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from screening for evaluation of a large,
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uh, axillary lymph node in the left breast.
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So these are the screening
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images for this patient.
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Everything looked pretty good, except that
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one of the lymph nodes in the left axilla
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was very prominent, no obvious fatty hilum.
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I'll just look at that a little bit more closely.
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This was the tomosynthesis images through
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that lymph node, and you never really get to
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a place where it looks like it has a fatty
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hilum, so pretty big lymph node, and that
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was larger compared to her prior mammogram.
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So we went ahead and asked the patient
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to come back in to have an ultrasound.
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So we did an ultrasound as our next step.
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And this was the ultrasound of the XLS.
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So there's a very large lymph node over three
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centimeters in size with an effaced fatty hilum,
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very small fatty hilum, and very thick cortex.
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Lots of internal blood flow.
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The cortex here is measured at six
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millimeters, but it's probably,
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you know, even thicker in this section.
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You know, there was actually a second lymph
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node that was also large with a thick cortex.
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And, um, the larger of the two lymph nodes
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was recommended for ultrasound-guided biopsy.
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So the patient had ultrasound-guided
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biopsy and that showed metastatic carcinoma
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consistent with a breast primary,
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even though the mammogram looked totally normal.
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And the next step in that situation
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is usually to go on to a breast MRI.
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to try to find the mass, which
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sometimes can be very small.
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And that's what happened in this patient.
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She had an MRI of the breast, which demonstrated a
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small mass, subsequently biopsied, and that was an
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invasive ductal carcinoma, which was presumed to
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be the source of this axillary nodal metastasis.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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