J Korean Soc Radiol.  2010 May;62(5):501-509. 10.3348/jksr.2010.62.5.501.

Radiologic Findings of Various Diseases of the Axillary Lymph Node with Pathologic Correlations

• Ryu GH
• Chang YW
• Kim HH
• Lee DW
• Kwon KH
• Choi DL
• Hwang JH
• Yang SB

• KMID: 2002961
• DOI: http://doi.org/10.3348/jksr.2010.62.5.501

Abstract

Axillary lymphadenopathy has multiple variable pathologic conditions such as a malignant or benign condition. It is important that we determine the radiologic findings of malignant lymphadenopathy and in turn determine the further course of evaluation for the lesion, because metastatic axillary lymphadenopathy represents an important prognostic factor. Recently, an ultrasonographic-guided axillary lymph node biopsy has been widely used as a diagnostic tool. We discuss the radiologic and pathologic findings of variable axilla diseases and outline the specific findings for determining the results of a lymph node biopsy.

MeSH Terms

Axilla
Biopsy
Lymph Nodes
Lymphatic Diseases
Lymphatic System

Figure

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  Fig. 1 Axillary ultrasonography finding of normal lymph node. Normal lymph node has a smooth, hypoechogenic, thin cortex (white arrow) with a centrally located, preserved relatively large sized fatty hilum.

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  Fig. 2 Reactive hyperplasia of lymph node in a 38-year-old women. A. Ultrasonography shows enlarged lymph node with eccentrical thickening of cortex and small sized fatty hilum. B. Ultrasonography guided 20G needle aspiration was performed and pathology reveals reactive hyperplasia of lymph node (white arrow).

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  Fig. 3 Tuberculosis in a 50-year-old women. Mammography shows calcified lymph nodes (black arrows) in both axilla that are possible of sequale of old pulmonary tuberculosis correlated with past history.

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  Fig. 4 Tuberculosis in a 46-year-old women. A. Ultrasonography shows abnormal multiple, hypoechoic enlarged lymph nodes (white arrow) with loss of hilar echogenecity. B. Photography reveals chronic granulomatous inflammation with caseous necrosis (H & E).

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  Fig. 5 Kikuchi disease in a 40-year-old women. A. Ultrasonography demonstrates a well-circumscribed, round or oval, hypoechogenic masses (white arrows) in left axilla. Sonoguided biopsy was performed using 14G needle. B. Contrast enhanced CT with MPR reconstruction image shows several homogeneous enhancing lymph nodes (white arrow) in left axilla. C. Photography of the biopsied lymph node demonstrates plump histiocytes intermixed with nuclear debris and lymphocytes. There is an absence of neutrophils and plasma cells (H & E).

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  Fig. 6 Castleman's disease in a 65-years-old women A. Ultrasonography shows several well-circumscribed, ovoid, hypoechogenic lymph nodes (white arrows) in left axilla. B. Contrast enhanced CT scan shows the multiple, conglomerated, enlarged lymph nodes (white arrow) with homogeneous enhancement in left axilla, level I. C. Photograph of a histopathologic specimen shows lymphoid follicles with stroma of hyperplastic capillaries, venules, and arterioles. In the germinal center, there is concentric layering of the multinucleated and pleomorphic follicular lymphocytes around the hyalinized central vessel (H & E).

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  Fig. 7 Toxoplasmosis in a 44-year-old women A. Ultrasonography shows enlarged lymph node with cortical thickening and fatty echogenicity in lymph node (white arrow) in hilar portion of left axilla. B. Color Doppler sonography shows increased hilar vascularity of lymph node. C. Photography reveals multiple small sized epithelioid granulomas (H & E).

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  Fig. 8 Metastatic lymphadenopathy from breast cancer in a 76-year-old women A. Ultrasonography shows about 1cm sized, enlarged lymph node (white arrow) with loss of fatty hilum and cortical thickening in right axilla. B. Contrast-enhanced CT scan shows enhancing LN (white arrow) in right axilla (level I).

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  Fig. 9 Metastatic lymphadenopathy breast cancer in a 37-year-old women A. Sonography shows enlarged lymph nodes (white arrow) in axilla with subcutaneous and skin nodules (white arrowheads). B. A enhanced CT scan with MPR reconstruction image shows conglomerated axillary lymph nodes (white arrows) (level I,II and III) with low-density necrotic portions, representing metastases.

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  Fig. 10 Metastatic lymphadenopathy from breast cancer in a 54-year-old women A. Sonography shows an enlarged lymph node (white arrow) between the pectoralis major and minor mulscle (Rotter's node). B. A multiplanar reformation (MPR) reconstruction image shows metastatic lymph nodes (white arrows) in left axilla level I, II. Identifying enlarged Rotter's node can be important because metastases can give rise to chest wall invasion.

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  Fig. 11 Metastatic lymphadenopathy from melanoma in a 45-year-old women A. Ultrasonography shows a lobulated heterogeneous hypoechoic mass (white arrow) and daughter nodules in left axillar. B. Contrast-enhanced CT scan with MPR reconstruction image shows multiple conglomerated, heterogeneously enhanced masses (white arrow) in left axillar.

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  Fig. 12 Axillary metastatic lymphadenopathy from primary breast malignant lymphoma in a 43-year-old women A. Ultrasonography shows lobulating, heterogeneous and hypoechogenic mass (white arrow) in right axilla. B. 18F FDG PET CT shows multiple FDG uptake right breast masses (white arrowhead) (SUV 22) and huge right axillary lymphadenopathies (white arrow) with FDG uptakes. C. Pathology revealed diffuse proliferation of large atypical lymphocystes compatible with diffuse large B-cell lymphoma (H&E).

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