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da Costa Vieira RA, da Rocha CA, Falcão-Junior PC, de Oliveira LCN. Lymph node microcalcifications after neoadjuvant chemotherapy: A therapeutic response marker. Breast Dis 2023; 42:17-21. [PMID: 36872760 DOI: 10.3233/bd-220025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Lymph node microcalcifications are rare events, and when they are accompanied by neoplasia, they usually seem to be associated with a metastatic condition. We present a case of a patient with breast cancer and lymph node microcalcifications undergoing neoadjuvant chemotherapy (NCT). A change in the calcification pattern towards becoming coarse was observed. Calcification represented a marker of axillary disease, and it was resected after NCT. This is the first report of a patient with lymph node microcalcification undergoing NCT. We observed a change in the calcification format, which facilitated lymph node sentinel identification. Pathological evaluation indicated metastatic disease.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Department of Surgical Oncology, Breast Division, Muriaé Cancer Hospital, Muriaé, MG, Brazil.,Department of Radiology, Breast Division, Muriaé Cancer Hospital, Muriaé, MG, Brazil
| | | | | | - Luiz Carlos Navarro de Oliveira
- Department of Surgical Oncology, Breast Division, Muriaé Cancer Hospital, Muriaé, MG, Brazil.,Department of Radiology, Breast Division, Muriaé Cancer Hospital, Muriaé, MG, Brazil
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2
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Yepes MM, Feliciano Y, Net J, Betancur V, Gomez-Fernandez C, Collado-Mesa F. Axillary lymph node "bubbly" calcifications and body tattoo: A case series and proposed algorithm to minimize lymph node biopsies. Breast Dis 2022; 41:397-406. [PMID: 36530068 DOI: 10.3233/bd-220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The presence of mammographically evident hyperdense foci within axillary lymph nodes elicits concern for calcium deposits, which in turn have a wide differential diagnosis including both benign and malignant entities. Tissue sampling, most commonly by way of image-guided core needle biopsy, is needed in many cases when a definite etiology cannot be clinically established. In this case series we present history, imaging findings, and pathology results (or long term follow-up stability as biopsy surrogate) of several women with body tattoos who at mammography were noted to have a characteristic pattern of "bubbly" pseudo-calcifications within axillary lymph nodes, and absence of other mammographic, sonographic and clinical abnormalities.
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Affiliation(s)
- Monica M Yepes
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yara Feliciano
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jose Net
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Fernando Collado-Mesa
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
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3
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Prabhu M, Jain D, Gupta SD, Bal C, Kumar R. Detection of Solitary Axillary Lymph Node Metastases from Hürthle Cell Carcinoma of the Thyroid on 18F-FDG PET/CT. Nucl Med Mol Imaging 2018; 52:389-393. [PMID: 30344789 DOI: 10.1007/s13139-018-0539-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022] Open
Abstract
Thyroid carcinoma is the most common neoplasm of endocrine malignancies. Differentiated thyroid carcinoma (DTC) constitutes 90% of the thyroid carcinomas, rest being medullary thyroid carcinoma (MTC), and anaplastic thyroid carcinoma (ATC). Distant metastases occur in up to 10% of patients with DTC. Metastases to axillary lymph nodes (ALN) are very rare. As per literature, only 25 cases have been reported. We report an unusual case of 47-year-old male with Hürthle cell carcinoma of the thyroid presenting with a solitary axillary lymph node metastasis 17 years after thyroidectomy, along with review of literature.
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Affiliation(s)
- Meghana Prabhu
- 1Department of Nuclear Medicine, All India Institute of Medical Sciences, E-81, Ansari Nagar (East), AIIMS Campus, New Delhi, 110029 India
| | - Deepali Jain
- 2Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Chandrasekhar Bal
- 1Department of Nuclear Medicine, All India Institute of Medical Sciences, E-81, Ansari Nagar (East), AIIMS Campus, New Delhi, 110029 India
| | - Rakesh Kumar
- 1Department of Nuclear Medicine, All India Institute of Medical Sciences, E-81, Ansari Nagar (East), AIIMS Campus, New Delhi, 110029 India
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4
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CT Findings of Axillary Tuberculosis Lymphadenitis: A Case Detected by Breast Cancer Screening Examination. Case Rep Radiol 2016; 2016:9016517. [PMID: 27379192 PMCID: PMC4917684 DOI: 10.1155/2016/9016517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/04/2016] [Indexed: 11/23/2022] Open
Abstract
We report the first description of CT findings of axillary tuberculous lymphadenitis confirmed by the pathological specimen. The breast cancer screening examination is one of the prime methods of detection of axillary tuberculous lymphadenitis. The most common site of axillary tuberculous lymphadenitis is the deep axilla. Screening mammography often fails to cover the whole axilla. The presence on the contrast-enhanced CT of unilateral multiple circumscribed dense nodes, some of which have large and dotted calcifications, might suggest tuberculous lymphadenitis in axillary region.
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Kamaleshwaran KK, Rajan F, Mohanan V, Shinto AS. Rare case of axillary lymph node metastasis in papillary thyroid carcinoma detected using Iodine-131 whole-body scintigraphy and single-photon emission computed tomography/computed tomography. Indian J Nucl Med 2015; 30:168-70. [PMID: 25829741 PMCID: PMC4379682 DOI: 10.4103/0972-3919.152985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Differentiated thyroid cancer is, usually, associated with an excellent prognosis and indolent course. Distant metastases are rare events at the onset of thyroid cancer. Among these presentations, metastasis to the axillary lymph nodes is even more unusual. Only few cases of papillary carcinoma with axillary nodal metastasis were previously reported in the literature. We present a 38-year-old female who underwent Iodine-131 whole-body scintigraphy, after total thyroidectomy and bilateral neck lymph node dissection for papillary carcinoma of thyroid, showed intense uptake in the remnant thyroid, lung metastasis, left cervical and left axillary lymph nodes. Excision of left axillary lymph nodes confirmed metastatic papillary carcinoma.
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Affiliation(s)
| | - Firoz Rajan
- Department of Surgical Oncology, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Vyshak Mohanan
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
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6
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Lee J, Jung JH, Kim WW, Hwang SO, Kang JG, Baek J, Kim HJ, Park JY, Jeong JY, Lim JY, Park HY. Ductal carcinoma arising from ectopic breast tissue following microcalcification observed on screening mammography: a case report and review of the literature. J Breast Cancer 2014; 17:393-6. [PMID: 25548589 PMCID: PMC4278060 DOI: 10.4048/jbc.2014.17.4.393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/23/2014] [Indexed: 11/30/2022] Open
Abstract
Ectopic breast tissue can occur anywhere along the incompletely regressed mammary ridge. Among the various types of breast choristoma, ectopic breast tissue, which has only glandular tissue without a nipple or areola, is most commonly detected in axillary areas. However, ectopic breast cancer is often not detected until significant clinical symptoms have been revealed, or diagnosis is delayed. Furthermore, an examination of ectopic breast tissue tends to be omitted from a screening mammography. Especially, the microcalcifications of ectopic breast tissue are difficult to delineate on mammography. Herein, the authors report a case of ectopic breast carcinoma that showed clustered microcalcifications on screening mammography, and discuss the interpretation and implications of microcalcification in ectopic breast tissue.
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Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Jin Hyang Jung
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Wan Wook Kim
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Seung Ook Hwang
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Jin Gu Kang
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Jino Baek
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Ji Young Park
- Department of Pathology, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Ji Yun Jeong
- Department of Pathology, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | | | - Ho Yong Park
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
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7
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Yactor AR, Michell MN, Koch MS, Leete TG, Shah ZA, Carter BW. Percutaneous tattoo pigment simulating calcific deposits in axillary lymph nodes. Proc (Bayl Univ Med Cent) 2013; 26:28-9. [PMID: 23382606 DOI: 10.1080/08998280.2013.11928907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The isolated finding of calcific deposits within axillary lymph nodes on mammography suggests a broad range of differential diagnoses, from benign causes such as granulomatous reaction secondary to previous histoplasmosis infection to malignancies such as breast cancer and metastatic disease from extramammary primary malignancies. Therefore, the isolated finding of intranodal calcium may warrant biopsy for a definitive diagnosis when a benign etiology is not apparent. We present a patient with isolated axillary lymph node densities on mammography and chest computed tomography, which were subsequently proven to represent deposition of tattoo pigment.
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Affiliation(s)
- Amy R Yactor
- Departments of Radiology (Yactor, Michell, Leete, Shah, Carter) and Pathology (Koch), Baylor University Medical Center at Dallas
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8
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Abstract
Although mammography is primarily used for the detection of breast cancer, it can occasionally reveal breast abnormalities related to extramammary disease. Cardiovascular diseases such as congestive heart failure and central venous obstruction may manifest as venous engorgement and breast edema at mammography. Pathologic arterial calcifications seen at mammography can indicate an underlying risk factor for accelerated atherosclerosis such as chronic renal failure. Connective tissue diseases including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis-polymyositis, and systemic scleroderma typically manifest with bilateral axillary lymphadenopathy, and stromal calcifications are also seen in the latter three disease processes. Some diseases such as neurofibromatosis type 1 and filariasis may manifest with pathognomonic findings at mammography, whereas other systemic diseases such as Wegener granulomatosis, sarcoidosis, and amyloidosis can manifest as nonspecific breast masses that are indistinguishable from breast cancer and usually require tissue biopsy for confirmation. Knowledge of the imaging characteristics of various systemic diseases affecting the breast will aid the radiologist in differentiating systemic disease from suspect breast lesions, thereby helping ensure appropriate follow-up. Furthermore, recognition of systemic diseases such as Cowden syndrome that are associated with an increased risk of breast cancer will allow the radiologist to recommend appropriate surveillance.
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Affiliation(s)
- Mailan M Cao
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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9
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Damle N, Singh H, Soundararajan R, Bal C, Sahoo M, Mathur S. Radioiodine avid axillary lymph node metastasis in papillary thyroid cancer: report of a case. Indian J Surg Oncol 2011; 2:193-6. [PMID: 22942610 DOI: 10.1007/s13193-011-0093-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 09/26/2011] [Indexed: 10/17/2022] Open
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10
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Burkill GJC, Allen SD, A'hern RP, Gore ME, King DM. Significance of tumour calcification in ovarian carcinoma. Br J Radiol 2009; 82:640-4. [PMID: 19332521 DOI: 10.1259/bjr/12716831] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to assess the pattern and significance of tumour calcification in ovarian carcinoma. Patients with calcifying ovarian carcinoma were identified from radiological reports. Their tumour characteristics, serum calcium levels, treatment and survival were compared with a control group of patients with non-calcifying disease. Patterns and distribution of calcification were assessed. Available serial CT scans were reviewed for changes in both soft-tissue and calcified disease according to RECIST (response evaluation criteria in solid tumours) criteria where feasible. Temporal changes in calcification were correlated with changes in soft tissue disease and CA125 levels. The calcified group numbered 122 (22 other patients had calcifying tumour but insufficient clinical data). Calcification in ovarian carcinoma had a prevalence of 8% (144/1721) in our series. There was a significant difference (p<0.001) between the two groups in the distribution of histological type, with serous tumours being more common in the calcified group (74/122 (61%)) than in the controls (509/1498 (34%)). The calcified tumour patients tended to have lower grade disease (p<0.001). No differences between the groups were found for age, treatment or serum calcium levels. Distribution of calcification was diffusely peritoneal in 34 patients, in association with a pelvic mass in 15, nodal in 11 and within the anterior abdominal wall in 2. There was no correlation between changes in calcification on serial CT scans and corresponding CA125 levels. In conclusion, calcification tends to occur most commonly in serous cystadenocarcinomata and in tumours of lower grade. Changes in calcification cannot be used as a marker of disease response.
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Affiliation(s)
- G J C Burkill
- Department of Radiology, The Royal Marsden Hospital, London, UK
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Seconda S, Zoundi Ouango O, Bouriel C, Burtin F, Audrain O, Levêque J. Microcalcifications intra-ganglionnaires axillaires : un piège diagnostique en sénologie. IMAGERIE DE LA FEMME 2006. [DOI: 10.1016/s1776-9817(06)73038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Groves AM, Warren R, Bobrow LG. Mammographic axillary node calcification caused by metastatic breast carcinoma. Breast 2002; 11:267-9. [PMID: 14965680 DOI: 10.1054/brst.2001.0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- A M Groves
- Department of Histopathology, Addenbrookes Hospital, Cambridge, CB2 2QQ, UK
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Singer C, Blankstein E, Koenigsberg T, Mercado C, Pile-Spellman E, Smith SJ. Mammographic Appearance of Axillary Lymph Node Calcification in Patients with Metastatic Ovarian Carcinoma. AJR Am J Roentgenol 2001; 176:1437-40. [PMID: 11373209 DOI: 10.2214/ajr.176.6.1761437] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We describe the mammographic appearance of axillary lymph node calcification in three patients with metastatic ovarian carcinoma. CONCLUSION Axillary lymph node calcification may be identified mammographically in patients with metastatic ovarian carcinoma and may be evidence of unsuspected metastatic disease. The pattern of calcification differs from that seen with metastatic breast carcinoma.
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Affiliation(s)
- C Singer
- Department of Radiology, Columbia University, College of Physicians and Surgeons at the New York Presbyterian Hospital, 161 Fort Washington Ave., AP 10, New York, NY 10032, USA
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