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PubMed2000

Treatment of morbidity associated with the management of the axilla in breast-conserving therapy.

The purpose of this study was to determine the impact of surgery and radiotherapy on late morbidity associated with the management of the axilla in breast cancer patients. Two hundred and sixty-six patients from a randomized breast conservation trial (DBCG-82TM protocol) were called in for a single follow-up interview and clinical examination of several functional outcome measures after a median of 6.6 years (3.5-10.5). All the patients were treated with lumpectomy and axillary dissection, followed by external beam radiotherapy to the residual breast. High-risk patients were given additional radiation to the regional lymph nodes plus adjuvant systemic treatment. Twenty-eight patients (11%) had arm edema (> or = 2 cm), which was associated with the extent of axillary node dissection as well as with age and radiotherapy (relative risk, RR = 4.5 (1.8-11.2, p = 0.001)). Impaired shoulder movement of any degree (7%) was associated with radiotherapy (RR = 4.0 (1.5-13.8, p = 0.007)) and advanced age (p = 0.002), while the extent of axillary dissection as described by the number of nodes retrieved was the only factor that predicted pain on logistic regression analysis (p = 0.02). A moderate to severe change in arm/shoulder strength and working ability was observed in 7% and 5% of patients, respectively, but no independent predisposing factor was discerned for these endpoints. It is concluded that the level of late functional morbidity several years after breast-conserving treatment is relatively low and clearly relates to age, extension of surgery, irradiation of the axilla or a combination of these factors, depending on the specific clinical outcome measure.

Adult↗
PubMed2005

Controversial ectopic thyroid: a case report of thyroid tissue in the axilla and benign total thyroidectomy.

A 43-year-old woman presented with a mass in her left axilla, which was surgically excised. Histologically, the tissue was a reactive lymph node with adjacent thyroid follicular tissue. The differential diagnosis included benign ectopic thyroid versus metastatic well-differentiated follicular-derived thyroid carcinoma. Because of the possibility of carcinoma, the patient underwent a diagnostic total thyroidectomy. The thyroid was grossly normal with no histologic evidence of malignancy. Post-operatively, the patient underwent a whole body 131I scan. Aside from an expected residual uptake in the thyroid bed region, there was no extrathyroidal uptake to suggest additional ectopic thyroid tissue or metastatic disease. At the time of this scan, her thyrotropin (TSH) was 92.8 microU/mL, thyroglobulin was less than 0.3 ng/mL, and thyroglobulin antibody was less than 3 IU/mL. Abnormalities in the embryologic development and migration of the thyroid gland can result in ectopic thyroid tissue. The most frequent locations are along the midline from the base of the tongue to the mediastinum. Only rare case reports exist of ectopic thyroid in other locations, including the chest (heart, trachea), abdomen (liver, gallbladder, pancreas), and pelvis (vagina). This case represents the first description of thyroid tissue in the axilla with a histologically benign thyroid gland.

Adult↗
PubMed2000

Antibiotic resistance patterns of aerobic coryneforms and furazolidone-resistant Gram-positive cocci from the skin surface of the human axilla and fourth toe cleft.

Samples of skin surface bacteria from 28 healthy subjects plated directly on to selective and non-selective media revealed that the proportion of aerobic coryneforms and furazolidone-resistant Gram-positive cocci (FURECs) resistant to erythromycin was significantly greater in the fourth toe cleft than in the axilla (P < 0.05). There were more erythromycin-resistant bacteria than tetracycline-resistant bacteria at both sites (P = 0.001 for the toe cleft; P < 0.01 for the axilla). In total, 160 distinct isolates were obtained, of which 42 were FURECs and 118 were aerobic coryneforms. Of these, 153 (96%) were resistant to erythromycin and 66 (41%) to tetracycline. All except seven of the tetracycline-resistant strains were also resistant to erythromycin. The resistant isolates belonged to a variety of species. CDC group ANF corynebacteria were most numerous and composed 31% of all isolates. The majority (76%) of FURECs were identified as Micrococcus luteus. MIC determinations on selected strains revealed that tetracycline-resistant FURECs were sensitive to doxycycline and minocycline, as were most tetracycline-resistant coryneforms. Nine coryneform isolates were cross-resistant to all three tetracyclines. Only a minority of erythromycin-resistant FURECs (21%) demonstrated a macrolide-lincosamide-streptogramin type B (MLS)-resistant phenotype with inducible or constitutive cross-resistance to clindamycin and the type B streptogramin, pristinamycin IA. Twenty-nine erythromycin-resistant FURECs had a novel phenotype distinct from MLS and macrolide-streptogramin type B resistance. In contrast, most coryneforms (79%) were MLS resistant. Among the remainder, two unusual erythromycin resistance phenotypes were apparent, both of which differed from the unusual phenotype in FURECs. This study has revealed that the non-staphylococcal aerobic flora of skin contains a considerable reservoir of tetracycline and erythromycin resistance determinants. The three unusual macrolide resistance phenotypes may be associated with novel resistance mechanisms.

Actinomycetales↗
PubMed1999

Adenocarcinoma with signet ring cells of the axilla showing apocrine features: a case report.

A 74-year-old Japanese man developed a reddish, indurated plaque composed of multiple nodules on his right axilla. Histopathologic examination showed a solid tumor that extended from the upper dermis into the subcutis, with both inter- and intracellular lumen formation, cellular arrangement in single files, a fibrotic reaction around the tumor cells, and the presence of mucinous material in the cytoplasm. There was both nuclear and cytoplasmic pleomorphism. Both lysozyme and GCDFP-15 were identified in the tumor cells. Electron microscopic examination showed periluminal condensation of the cytoplasm. Because thorough clinical and laboratory examinations were unremarkable, we regarded this to be a case of primary adenocarcinoma with signet ring cells of the axilla. The neoplasm might have differentiated toward the apocrine sweat glands or the mammary glands. Radiation therapy was effective to some degree. This seems to be the first reported case in which adenocarcinoma with signet ring cells of the skin affected a site other than the eyelids.

Aged↗
PubMed1999

Apocrine gland carcinoma of the axilla: review of the literature and recommendations for treatment.

Apocrine gland carcinoma is a rare form of sweat gland neoplasm with a distinctive cytologic appearance. Although the region of the axilla remains the most common site for these tumors, apocrine gland carcinoma of the anogenital region, eyelid, ear, chest, wrist, lip, foot, toe, and finger have been reported. Classically, these slow-growing lesions present as painless, colorless or reddish, firm or cystic nodules. More than half of the reported patients with apocrine carcinoma had lymph node metastases at the time of diagnosis. Wide local excision is standard therapy for these lesions. A therapeutic lymph node dissection is indicated for confirmed lymph node metastases and may have a role in the setting of a large or highly aggressive tumor with narrow surgical margins. Although apocrine gland carcinoma responds poorly to chemotherapy, adjuvant radiotherapy may be used in advanced local or regional disease. The authors describe a 69-year-old man with a large recurrent apocrine gland carcinoma of the axilla treated with en bloc excision with axillary dissection and offer a pertinent review of the English literature and recommendations for treatment.

Aged↗
PubMed1994

Pilonidal sinus of the axilla: report of five patients and review of the literature.

Five patients with a pilonidal sinus of the axilla--thought to be the 9th to 13th described in the literature--are reported. All patients were nonhirsute, healthy women aged 17 to 30 years. One or two hairs were seen macroscopically and histologically in 3 of 5 patients, and 1 hair was seen macroscopically in the remaining 2 patients. Friction (abduction-adduction) or suction, as well as assorted factors such as shaving, minor infection, and maceration, seemed to be the most probable cause of pilonidal sinus of the axilla. Complete resection, including the openings of 1 or 2 sinuses, is the only suitable treatment for axillary suppuration.

Adolescent↗
PubMed1995

Monitoring the axilla in patients with silicone gel implants.

Migration of silicone beyond the breast implant capsule may occur as a result of silicone bleed, leak, or rupture, and it may indicate failure of implant envelope integrity. We report a series of 23 patients with silicone implants who had axillary lymph node biopsies for palpable masses. Group 1 (n = 15) had biopsies performed an average of 6 years following aesthetic augmentation, and Group 2 (n = 8) had biopsies performed an average of 5 years after mastectomy reconstruction. All biopsies demonstrated foreign body reaction consistent with silicone migration. Five patients in Group 1 and two in Group 2 also had breast cancer detected by the axillary biopsy. Evaluation of the axilla utilized a combination of one or more techniques, including mammography, ultrasonography, magnetic resonance imaging, and fine-needle aspiration. We conclude that (1) routine evaluation of the axilla is mandatory in all patients with silicone breast implants; (2) an algorithmic approach in diagnosing axillary masses may be helpful, especially in augmentation patients; and (3) axillary masses detected by clinical examination or other means must be biopsied, even in the face of negative screening studies, because breast cancer may be coincidental with a silicone granuloma.

Adult↗
PubMed1975

Surgical treatment of hidradenitis suppurativa of the axilla.

We review our surgical experience with hidradenitis suppurativa of the axilla at Cook County Hospital during the years 1963 to 1972. The operation for this entity described by Pollock et al has (1) reduced the length of hospitalization, (2) increased the rate of primary healing and reduced the period of secondary healing, (3) allowed a great amount of tissue to be excised, (4) permitted both axillae to be operated on at once (without incapacitating the patient), (5) avoided the need for skin grafting, and (6) has had less morbidity for those patients in whom primary healing is not achieved. We believe the method reported by Pollock et al is now the treatment of choice for this disease.

Axilla↗
PubMed1997

Primary breast cancer in aberrant breast tissue in the axilla.

Primary breast cancer in aberrant axillary breast tissue is rare. Breast cancer in the axilla is most often due to lymph node metastases from an ipsilateral breast tumor or from an occult primary lesion. We describe two patients with primary breast cancer in aberrant breast tissue in the axilla, and review the literature to define guidelines for diagnosis and treatment.

Adenocarcinoma↗
PubMed2005

Fibroadenoma of the axilla.

BACKGROUND: Ectopic, axillary breast tissue can develop any disease that affects the normal breast, including fibroadenoma. OBJECTIVE: To report and discuss a case of fibroadenoma of the axilla in a 23-year-old woman. METHODS: Case report and discussion of the rare entity of fibroadenoma of the axilla. RESULTS: The histology was identical to the fibroadenomas seen in the breast and those observed along the milk line. CONCLUSION: Differential diagnosis of an axillary tumor should include ectopic breast tissue.

Adult↗
PubMed2006

Immunohistochemical differentiation and localization analysis of sweat glands in the adult human axilla.

BACKGROUND: The classic concept of axillary glands differentiates between eccrine glands, producing abundant clear, nonodorous sweat; and apocrine glands, excreting small amounts of turbid, odorous milky sweat. A third type of sweat glands, the "apoeccrine" glands, were recently identified. To define the different types of sweat glands and their location and number, the authors carried out a prospective histologic study on adult human axillary skin, including various immunohistochemical markers. METHODS: Forty-three consecutive Caucasian, subjectively normhidrotic patients, who underwent a surgical procedure in the axilla unrelated to the axillary glands, were included in the study. For verification of normhidrosis, the gravimetric test was carried out by measuring the amount of sweat secretion per minute. Then, a 1 x 1-cm measuring piece of skin and subcutaneous tissue was excised in the apex of the axilla, divided into three samples--altogether, 129 samples--and processed for histologic examination. RESULTS: In the dermis, the authors found only very few eccrine (average, 0.3 gland/cm in only 12 percent of all patients) and apocrine glands (average, 0.1 gland/cm in only 4.7 percent of patients), and no apoeccrine glands in any patient. In the subcutaneous tissue, the mean number of glands per centimeter squared was 10 for the eccrine glands, nine for the apocrine glands, and six for the apoeccrine glands. CONCLUSIONS: In the authors' Caucasian subjects, all or most of the sweat glands were found in the subcutaneous tissue near the border to the dermis and not in the dermis. For extremely hyperfunctioning sweat glands, the authors recommend less radical surgical methods, with the preservation of skin, based on the knowledge that most glands are localized in the subcutaneous tissue.

Adult↗
PubMed2004

Dermatofibrosarcoma protuberans arising from a burn scar of the axilla.

It is well-known that the development of a malignant tumor in a chronic burn scar is one of the long-term complications of a severe burn. Most of these tumors are squamous cell carcinomas, and sarcomas are much rarely seen in chronic burn scars. In the previous literature, 24 cases of burn scar sarcomas were reported. The authors report the second case of dermatofibrosarcoma protuberans arising in a chronic, severe burn scar. A 68-year-old woman with a reddish tumor in the right axilla was referred to the authors' hospital. The patient had sustained severe burns in the right axilla, upper arm, and trunk at the age of 6 years. A biopsy specimen revealed dermatofibrosarcoma protuberans. There was no evidence of distant metastasis. The tumor was excised widely to include the surrounding burn scar. Two years after the operation, there was no evidence of tumor recurrence. As surgeons, we should recognize the possibility of the occurrence of various malignant tumors including sarcomas on burn scars.

Aged↗
PubMed1981

The microbiology of the human axilla and its relationship to axillary odor.

The axillary microflora of 229 subjects was characterized quantitatively and the results correlated with whether the odor was pungent body odor or instead a faint "acid odor". The axillary flora was found to be a stable mixture of Micrococcaceae, aerobic diphtheroids and Propionibacteria. Significantly higher numbers of bacteria were recovered from the axilla of those with pungent axillary odor than in those with acid odor. Aerobic diphtheroids in high numbers were recovered in all subjects having typical body odor. These included lipophilic as well as large-colony diphtheroids. When droplets of apocrine sweat placed on the forearm were inoculated with various bacteria which reside in the axilla, only diphtheroids generated typical body odor. Cocci produced a sweaty odor attributable to isovaleric acid.

Adolescent↗
PubMed1984

Colonization of the axilla by Propionibacterium avidum in relation to age.

The prevalence of Propionibacterium avidum in the axillae of 248 individuals aged 5 to 18 years was studied. Both caucasoids and negroids, males (132) and females (116), were included. The frequency of recovery of the organism increased with age and was associated with the onset of puberty. The organism was recovered from only 2 of 40 females (5%) aged 5 to 10 years and from 1 of 22 males (4.5%), whereas 45% of females and 58% of males aged 15 to 16 years were colonized. Females tended to become colonized at an earlier age than males did. It appeared that negroids carried the organism more frequently than caucasoids, but the difference in prevalence was not statistically significant in matching age groups. It is suggested that the increase of hydration of the axilla with age and increase in substrate availability play an important part in the colonization process.

Adolescent↗
PubMed1976

Multiple lymphangiomas of the neck, axilla, mediastinum, and bones in an adult.

Whereas lymphangiomas of the neck, axilla, or mediastinum are not uncommon in children, they are rarely found in the adult, and primary lymphangioma of bone is very rare. The authors report a case of multiple lymphangiomas of the neck, axilla, mediastinum, and bones in a 34-year-old man, which they believe to be only the second such case reported thus far.

Adult↗
PubMed1996

Half-Fourier, three-dimensional technique for dynamic contrast-enhanced MR imaging of both breasts and axillae: initial characterization of breast lesions.

PURPOSE: To evaluate the ability of asymmetric half-Fourier three-dimensional (3D) magnetic resonance (MR) imaging to characterize signal intensity changes in breasts and axillae after contrast material injection and to compare the spatial resolution and measured signal intensity change of asymmetric and symmetric (keyhole) partial Fourier techniques. MATERIALS AND METHODS: Imaging was performed in 28 adult patients by collecting a single full-Fourier 3D data set with bolus injection of contrast material during the last 10 seconds followed by collection of six half-Fourier 3D data sets without interimage delays. Postcontrast keyhole and half-Fourier images were formed from the same full-Fourier raw data set. RESULTS: The asymmetric half-Fourier 3D technique maintained the spatial resolution and lesion signal intensity of the full-Fourier image, whereas the 50% keyhole method degraded the spatial resolution by a factor of two and decreased the lesion signal intensity by 19% for a 2 x 2-pixel region of interest. Histopathologic correlation was attained in 32 lesions in 28 patients. Sensitivity was 100% (five of five) and specificity was 89% (24 of 27). CONCLUSION: The asymmetric half-Fourier 3D MR imaging technique allows imaging of both breasts and axillae without loss of lesion contrast or temporal resolution and provides the maximum spatial resolution and lesion signal intensity attainable for the views sampled.

Adult↗
PubMed1999

Two cases of cutaneous apocrine ductal carcinoma of the axilla. Case report and review of the literature.

We report 2 cases of cutaneous apocrine ductal carcinoma (CADC) of the axilla in a 64- and a 54-year-old male. Histological examination revealed 2 solid, ductal and glandular tumors with decapitation secretion. Tumor cells showed cellular and nuclear atypism, and infiltrative growth of tumor cell nests was also observed. Although there were no characteristic features of extramammary Paget's disease on the overlying skin, case 1 exhibited a typical Paget's phenomenon. We concluded that the Paget's phenomenon of case 1 was a result of upward extension of the tumor in the dermis. The neoplastic cells of both cases were immunohistochemically positive for gross cystic disease fluid protein, lysozyme, CD15 and carcinoembryonic antigen but negative for S-100 protein. Based on these findings, we concluded that these tumors were cutaneous apocrine ductal carcinomas. There was no evidence of tumor remnants in the axilla, and the patients have shown no signs of local recurrence or metastasis. We also reviewed the literature and summarize here the clinical features of CADC.

Adenocarcinoma↗
PubMed2002

Dynamic contrast enhanced MRI of the axilla in women with breast cancer: comparison with pathology of excised nodes.

Axillary lymph node status is the most important prognostic factor in breast cancer patients and is currently determined by surgical dissection. This study was performed to assess whether dynamic gadopentetate dimeglumine (Gd) enhanced MRI is an accurate method for non-invasive staging of the axilla. 47 women with a new primary breast cancer underwent pre-operative dynamic Gd enhanced MRI of the ipsilateral axilla. Lymph node enhancement was quantitatively analysed using a region of interest method. Enhancement indices and nodal area were compared with histopathology of excised nodes using a receiver operating characteristic (ROC) curve approach. 10 patients had axillary metastases pathologically and all had > or =1 lymph node with an enhancement index of >21% and a nodal area of >0.4 cm(2). 37 patients had negative axillary nodes pathologically. 20 of these had enhancement indices <21% and nodal areas <0.4 cm(2). Using this method, a sensitivity of 100%, a specificity of 56%, a positive predictive value of 38% and a negative predictive value of 100% could be achieved. Using this method of quantitative assessment, dynamic Gd enhanced MRI may be a reliable method of predicting absence of axillary nodal metastases in women with breast cancer, thereby avoiding axillary surgery in women with a negative MRI study.

Aged↗