Axillary Lymph Nodes with Necrosis and Non-Caseation - USMLE Forums
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  #1  
Old 10-01-2012
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Microscope Axillary Lymph Nodes with Necrosis and Non-Caseation

A 42 yr old woman with history of breast cancer comes to the physician for evaluation..she states thats she is able to feel certain lumps in her axilla from a week, which are not tender to touch...she is a known breast cancer pt. who treated by breast reconstruction surgery 2yrs ago...
on further examination physician notices the nodes and send for biopsy..biopsy states the necrotic nodules with non-caseation..what is the underlying cause in it..?

a) metastatic foci of breast cancer which was unmasked 2 yrs ago
b) reactivation of her previous cancer
c) lymphatic obstruction from the surgery
d) due to the medication side effect
e) foreign body reaction
f) nothing to worry those are pathognomic lesions for adenoma
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Old 10-01-2012
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Default Bb

.................B
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Old 10-02-2012
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My answer is B) Reactivation of previous cancer.
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Old 10-02-2012
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Correct Answer E is right

the correct answer is E) foreign body reaction......

i think this question is more of step 2 ck(surgery)...may come under patho too....

the buzz word in this question is noncaseation necrosis
neither the breast cancers presents with noncaseation...excpt comedo carcinoma presents with caseation necrosis(not noncaseating though)

breast cancer treated with breast reconstruction surgery usually presents with non caseation----coz BRS usually done by implanting breast implants..which lead to inflammation and further release of cytokines(IL12--activates CD4T helper---which further produce IFN gamma for macrophages and turns into reactive histiocytes..)

it can't be adenoma though...coz generally nontender lymph nodes accompany malignancy...and it's not due to reactivation of previous cancer either coz the source is from implants.....
usually lymph node masking is not seen....physicians evaluate breast cancer prognosis primarily by axilary lympphnode status..

the other important noncaseating granulomas are seen in sarcoidosis, berrylliosis
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Old 10-02-2012
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@vencky
thanx alot for the questions
but this lymph node is non tender;so in reactive lymphadenopathy,my belief is that they are all painful.
am i making a wrong generalization here?thank you
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Old 10-02-2012
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Quote:
Originally Posted by blade View Post
@vencky
thanx alot for the questions
but this lymph node is non tender;so in reactive lymphadenopathy,my belief is that they are all painful.
am i making a wrong generalization here?thank you
ya you're right....my mistake should have given it as tender .....and also sometimes may not be present as tender though but that not comes under this vignette..should have given as a tender one.....thanks
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Old 10-02-2012
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Quote:
Originally Posted by venky2600 View Post
ya you're right....my mistake should have given it as tender .....and also sometimes may not be present as tender though but that not comes under this vignette..should have given as a tender one.....thanks


That will be a bonus mark in the exam
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Old 10-02-2012
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Originally Posted by blade View Post
That will be a bonus mark in the exam
haha, ya but this question was prepared by me that's the reason mistakes can exist
bu in real one..usually proffesionals prepare it...(hope we may get 1 bonus mark as a good luck).....
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