Unusual Clinical Tumor Development in Axilla

Abstract

R e c e i ve d M ay 3 0 , 2 0 1 3 ; A c c e p t e d A u g u s t 1 4 , 2 0 1 3 . Key words: Axilla -Sarcoma -Neurogenic sarcomaAbstract: This work describes clinical development of a sarcoma in the left axilla of a 36-year-old woman. The macroscopic picture changed from the initial inflammatory reddening to globular resistance of 2.5 cm, suggestive of an enlarged lymph node. Mammography did not reveal any associated breast disease. Colliquation found on the ultrasound images led to a biopsy, the result of which indicated only an inflammation, without any malignancy. Rapid growth of the axillar tumor to 10 cm in size within 8 weeks prompted surgery allowing proper diagnosis of a small mature-to-immature sarcoma. Special examinations performed by a histopathologist (at the Institute for Histopathology) could not establish the precise histogenesis, i.e. the tissue origin. Therefore it was necessary to remove any clinically obscuring tumor for the final proper histological diagnosis and adequate treatment of the patient. Prague Medical Report / Vol. 114 (2013) No. 3, p. 191-196 IntroductionIn the personal anamnesis of our 36-year-old patient (G2/P2) no relation to the present ailment was found. The gynecological anamnesis showed two spontaneous child births, after the second birth a conization was performed, which had a histological finding of CIN 2. The patient used hormonal contraceptives, which was changed after the conization to IUD -Mirena. The patient's weight was 65 kg, and her height was 165 cm.At a regular gynecological check-up the patient indicated an inflammatory lesion in her left armpit, with a reddish area reminiscent of folliculitis. The patient was given local treatment, and subsequently the inflammation subsided. 3 weeks later the patient returned having found an axillar resistance which was movable with restrictions. The skin over the formation was without any pathological findings.On 23 April 2012 there a mammography was performed to establish any correlation with the breast area. The mammographic type was glandular; an ultrasonic check discovered a small cyst to the left in the top outside quadrant, while in the right breast two fibromas about 4 mm in size were found in the top outside quadrant behind the nipple areola, and in the left axilla there was a globular hypoechoic node with slight vascularization in the periphery, 28 mm in size, of an infiltrated character. After consulting the mammography center, a biopsy using an ultrasound was undertaken. Puncture samples from the resistance were processed into a block and sliced up in their entirety. Microscopic image showed ligament and adipose tissue with vessels and nerves and sparse uncharacteristic globo-cellular cellularization. No structures of lymph nodes were present, and the samples did not contain any tumor growth. The patient came for a check-up two weeks later. Owing to the negative histological result, and based on the confirmed chronic nodes in the right axilla, we performed only a supplementary examination, resulting in the decis...