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Lymphonodopathy is an increase in volume and/or changes in the characteristics of lymph nodes, and it can be caused by benign or malignant diseases. Appropriate physical examination should define their clinical characteristics, and, if needed, complementary imaging or anatomopathological tests should be performed for diagnostic definition. In the present article, we report the case of a female patient, with sarcoidosis, who presented axillary lymph node disease, and the exams that followed until the diagnostic conclusion.

Introduction: Occult breast carcinoma is a rare presentation of breast cancer, with histological evidence of axillary lymph node involvement and clinical and radiological absence of malignant breast lesions. Its survival is similar to that of the usual presentation. The treatment consists of modified radical mastectomy or axillary drainage with breast irradiation, resulting in similar survival, associated with systemic therapy according to the staging. Neoadjuvant therapy should be considered in N2-3 axillary cases. Differential diagnoses of axillary lymphadenopathies include: non-granulomatous causes (reactive, lymphoma, metastatic carcinoma) and granulomatous causes (infectious – toxoplasmosis, tuberculosis, sarcoidosis, atypical mycobacteria). Objectives: To report the case of a patient who needed a differential diagnosis among the various causes of axillary lymphadenopathy. Methods: This is a literature review conducted in the PubMed database, using the keywords "granulomatous lymphadenitis", "breast sarcoidosis", "occult breast cancer". Inclusion and exclusion criteria were applied. Case report: V.F.S., female, 51 years old, was referred to an evaluation of axillary lymphadenopathy in May 2019. She was followed by the department of pulmonology due to mediastinal sarcoidosis since 2017. Physical examination indicated breasts without changes. Axillary lymph nodes had increased volume and were mobile and fibroelastic. Mammography revealed only axillary lymph nodes with bilaterally increased density, and the ultrasound showed the presence of atypical bilateral lymph nodes. Neither presented breast lesions. Axillary lymph node core biopsy was compatible with granulomatous lymphadenitis. This result corroborates the diagnosis of sarcoidosis affecting peripheral lymph nodes. The patient was referred back to the department of pulmonology, with no specific treatment since she is oligosymptomatic. Discussion: Despite the context of benign granulomatous disease, malignancy overlying the condition of sarcoidosis must be ruled out. The biopsy provided a safe and definitive diagnosis, excluding the possibility of occult breast carcinoma. The patient will continue to undergo breast cancer screening as indicated for her age and usual risk. Conclusion: In the presentation of axillary lymphadenopathy, the mastologist must know the various diagnoses to be considered. The most feared include lymphoma and carcinoma metastasis with occult primary site. A proper workup can determine the diagnosis and guide the appropriate treatment.

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Introduction: Reconstruction of the nipple-areola complex (NAC) is the last step in breast reconstruction after a radical mastectomy. There are several techniques to perform NAC reconstruction and the most common described involve local flaps and skin grafts. However, they depend on good vascularization at the receptor site, which is often impaired in mastectomies with prosthetic reconstruction, often associated with an irradiated tissue, increasing risk of ischemia and necrosis of the new NAC. Tattooing of the NAC is an alternative to the surgical procedures and has gained space over the years, due to its ease, rapid recovery, and low rate of complications. A tattoo consists in placing pigments in the dermis, through perforations in the skin by different combinations of needles, called cartridges. Such pigments are currently synthetic, based on iron oxides and titanium dioxides dispersed in a suspended gel, offering safety with rare adverse events. Case report: Female, 62 years old, who had a modified radical mastectomy in 2008 for treatment of invasive breast cancer in another institution. In 2012, she started her follow-up at Santa Casa de Misericórida de Belo Horizonte and had a reconstruction using a latissimus dorsi myocutaneous flap with a prosthesis, associated with skin grafting for reconstruction of the areola and papilla and a reduction mammaplasty on the left. After discussing options and understanding patients’ expectations, an oval areola on the right was planned, similar to the left one. Lidocaine based topical anesthetics was applied, followed by a complete tattoo of the right NAC, using a 3D technique for the papilla. The machine used was TH PRO NeonPEN Slim® and needle cartridges 1RL, 3RL, 5RS and 7RM from the same brand. Dressing was performed with La Roche Cicaplast® ointment, covered with a plastic film, which was changed daily by the patient for 15 days, according to medical advice. After 40 days the bilateral oval shape. However, the patient was not satisfied, so we planned to transform it into a round areola. Tattooing of the round areola and retouching of details for the right papilla were performed, in addition to the left areola pigmentation, to symmetrize color and shape. Figure 3 illustrates the results 15 days after the second and last session, with similarity between color and areolar shape, as well as an effect of depth and projection on the right papilla. A subjective evaluation of outcome was carried out, with the patient claiming satisfaction with the procedure and feeling better about her breasts.