Axillary Adenopathy - Unilateral / Chronic Lymphocytic Leukemia (CLL)
HIDEInteractive Transcript
0:01
This is a 59 year old female presenting for a screening mammogram.
0:06
You'll notice right away that the screening mammogram I'm showing you is
0:09
a 2D full field digital mammogram, not tomosynthesis. We've interpreted
0:14
this mammogram as normal, which makes sense given lack of imaging findings,
0:20
axilla looks okay. I wanna show you the patient presenting three years later
0:25
for the same screening mammogram. And right away, you can see that the
0:30
imaging appearance of the left axilla has changed. There's numerous large
0:36
axillary lymph nodes projecting over that axillary tail, axilla region,
0:40
which have appeared since the prior exam. Now of course, we don't see
0:45
those on the screening exam. It's hard for us to image the axilla. I'm
0:49
gonna pull down just the left MLO view so we can look at
0:54
this tomo. Tomo findings won't be that specific, they'll again show us our
0:59
large axillary lymph nodes with an overall oval appearance, circumscribed
1:07
margin. Not surprisingly, we don't really see the
1:11
high limb in these lymph nodes, and that's not uncommon, but of course
1:15
these do look very rounded in comparison to more normal appearing lymph
1:19
nodes. I'm gonna pull down her prior left MLO image
1:25
just as a point of comparison, and you can see much more normal
1:28
appearing lymph nodes in the left axilla. So these abnormal nodes have developed
1:34
since that time. And of course, when we're looking at this case,
1:38
we realize that this is unilateral axillary adenopathy. And the primary
1:44
differential diagnosis for unilateral axillary adenopathy is of course malignancy.
1:48
And usually an associated malignancy within the same breast.
1:53
We don't see anything on this screening exam, and that may not be
1:56
too surprising because sometimes we know that the sensitivity of mammography
2:01
is not perfect, and we may not ever see anything on the screening
2:05
exam. So this patient was recommended for further evaluation with axillary
2:10
ultrasound. She underwent that axillary ultrasound, again demonstrated multiple
2:15
large abnormal lymph nodes in the left axilla. One of these was subsequently
2:19
biopsied, demonstrating CLL, chronic lymphocytic leukemia, lymphoma, and
2:26
she went on to further treatment. Sometimes if we did see this abnormal
2:31
nodes in the left axilla, and they were proven to be a metastatic
2:35
breast cancer, and we didn't see anything on the mammogram, we would recommend
2:40
an MRI for further evaluation to further evaluate any
2:44
potential smaller malignancy in that ipsilateral breast, which might be
2:49
contributing to this metastatic to be used in the axilla. But in this
2:53
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
© 2025 Medality. All Rights Reserved.