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What Causes Pain Under Armpit And Arm Heaviness?
Question: Hi Doctor,
Hope you are having a good day.
On July 28, I felt pain under armpit and arm heaviness. I went to a Gynaecologist. She said I have a bacterial infection of the armpit hair shafts. She prescribed antibiotic (Cefurxime/Axetil) 500 mg every 12 hours for 7 days, Cream, and alcohol swabs. Within two days I felt much better and within 4 days the pain is gone.
Because I worked as a volunteer graphic designer with non-profit breast cancer organization to fight and prevent breast cancer in Saudi Arabia as it is the #1 cancer in my country. I knew that pain in armpit and axillary swelling could be related to breast cancer, so I asked the doctor for breast ultrasound to make sure there's nothing in my breasts.
I had 2 ultrasounds
The first one showed:
- Normal external boundaries of both breasts, showing normal skin, nipple and areola. Normal smooth texture of the subcutaneous fat.
- Well-defined small oval mass measures 13x10 mm seen in the upper quadrant of the right breast at 12 o'clock. The mass shows heterogenous mainly echotexture with no degeneration or calcifications. The mass gives no posterior acaustic shadowing.
- The remaining breast tissue has diffuse dense texture.
- No abnormal calcifications could be seen. No intramammary enlarged lymph glands.
- Normal retromammary layers and normal visualized parts of the pectoralis muscles.
- Normal axillart tao; at both sides with bilateral enlarged lymph nodes with preserved hilum & no pathological change seen. The largest seen at right axilla measure 19x9mm.
Conclusion:
A right breast mass highly suggestive for fibroadenoma for excision and biopsy
----------------
After 4 days I had an appointment with surgeon and he asked for second ultrasound. it showed well-defined hypoechoic focal lesion of 16x10 mm in size seen at at 12 o'clock 3 cm from the nipple suggesting fibroadenoma for FNA biobsy.
- Both breasts show highly reflective breast parenchymal echotexture predominantly glandular pattern.
- No dilated ducts.
- Bilateral axillary few lymph nodes the largest is seen in the right axilla measuring 21x7 mm. All are typical in appearance suggesting reactionar lymph nodes.
IMPRESSION:
- Right breast focal lesion suggesting fibroadenoma for biopsy.
- Bilateral Breast fibroadenosis.
- Bilateral axillary reactionary lymph nodes.
---------
- I had biopsy on August 8.
Results of the biopsy:
Gross Appearance:
Specimen consists of two cores of grayish white tissue measuring together 1.5x0.1 cm. Submitted in toto (all/1)
Histology:
Breast Glandes surrounded by a fibrous stroma.
Diagnosis:
This picture is consistent with PHYLLODES TUMOUR
---------
- I had a new ultrasound yesterday:
- Normal external boundaries of both breasts, showing normal skin, nipple and areola. Normal smooth texture of the subcutaneous fat.
- well-defined small oval mass measures 15x13x10 mm seen in the upper quadrant of the right breast at 12 o'clock. The mass shows heterogenous mainly echotexture with no degeneration or calcifications. The mass gives no posterior acaustic shadowing.
- The remaining breast tissue has diffuse dense texture.
- No abnormal calcifications could be seen. No intramammary enlarged lymph glands.
- Normal retromammary layers and normal visualized parts of the pectoralis muscles.
- Normal axillary tail at both sides with no enlarged lymph nodes.
Conclusion:
Relatively Stationary coarse of the breast mass as described
Hope you are having a good day.
On July 28, I felt pain under armpit and arm heaviness. I went to a Gynaecologist. She said I have a bacterial infection of the armpit hair shafts. She prescribed antibiotic (Cefurxime/Axetil) 500 mg every 12 hours for 7 days, Cream, and alcohol swabs. Within two days I felt much better and within 4 days the pain is gone.
Because I worked as a volunteer graphic designer with non-profit breast cancer organization to fight and prevent breast cancer in Saudi Arabia as it is the #1 cancer in my country. I knew that pain in armpit and axillary swelling could be related to breast cancer, so I asked the doctor for breast ultrasound to make sure there's nothing in my breasts.
I had 2 ultrasounds
The first one showed:
- Normal external boundaries of both breasts, showing normal skin, nipple and areola. Normal smooth texture of the subcutaneous fat.
- Well-defined small oval mass measures 13x10 mm seen in the upper quadrant of the right breast at 12 o'clock. The mass shows heterogenous mainly echotexture with no degeneration or calcifications. The mass gives no posterior acaustic shadowing.
- The remaining breast tissue has diffuse dense texture.
- No abnormal calcifications could be seen. No intramammary enlarged lymph glands.
- Normal retromammary layers and normal visualized parts of the pectoralis muscles.
- Normal axillart tao; at both sides with bilateral enlarged lymph nodes with preserved hilum & no pathological change seen. The largest seen at right axilla measure 19x9mm.
Conclusion:
A right breast mass highly suggestive for fibroadenoma for excision and biopsy
----------------
After 4 days I had an appointment with surgeon and he asked for second ultrasound. it showed well-defined hypoechoic focal lesion of 16x10 mm in size seen at at 12 o'clock 3 cm from the nipple suggesting fibroadenoma for FNA biobsy.
- Both breasts show highly reflective breast parenchymal echotexture predominantly glandular pattern.
- No dilated ducts.
- Bilateral axillary few lymph nodes the largest is seen in the right axilla measuring 21x7 mm. All are typical in appearance suggesting reactionar lymph nodes.
IMPRESSION:
- Right breast focal lesion suggesting fibroadenoma for biopsy.
- Bilateral Breast fibroadenosis.
- Bilateral axillary reactionary lymph nodes.
---------
- I had biopsy on August 8.
Results of the biopsy:
Gross Appearance:
Specimen consists of two cores of grayish white tissue measuring together 1.5x0.1 cm. Submitted in toto (all/1)
Histology:
Breast Glandes surrounded by a fibrous stroma.
Diagnosis:
This picture is consistent with PHYLLODES TUMOUR
---------
- I had a new ultrasound yesterday:
- Normal external boundaries of both breasts, showing normal skin, nipple and areola. Normal smooth texture of the subcutaneous fat.
- well-defined small oval mass measures 15x13x10 mm seen in the upper quadrant of the right breast at 12 o'clock. The mass shows heterogenous mainly echotexture with no degeneration or calcifications. The mass gives no posterior acaustic shadowing.
- The remaining breast tissue has diffuse dense texture.
- No abnormal calcifications could be seen. No intramammary enlarged lymph glands.
- Normal retromammary layers and normal visualized parts of the pectoralis muscles.
- Normal axillary tail at both sides with no enlarged lymph nodes.
Conclusion:
Relatively Stationary coarse of the breast mass as described
Brief Answer:
needs to be excised
Detailed Answer:
Hi
Thanks for your query.
You have already had a biopsy which is suggestive of Phyllodes tumor. Now Phyllodes tumor can be totally benign, or borderline malignant or fully malignant. Going by the description in your report, it looks more like the benign variant.
The ultrasound is also suggestive of benign tumor. In fact, benign Phyllodes tumor is often confused with fibroadenoma on USG. The nodes all have normal morphology and have preserved fatty hilum so they are probably not involved by tumor.
Hence the treatment should be simple excision of the tumor and submitting it for biopsy. It will suffice for treatment as well as confirmation of final diagnosis.
Hope this helps. I will be available for further follow up.
Regards
needs to be excised
Detailed Answer:
Hi
Thanks for your query.
You have already had a biopsy which is suggestive of Phyllodes tumor. Now Phyllodes tumor can be totally benign, or borderline malignant or fully malignant. Going by the description in your report, it looks more like the benign variant.
The ultrasound is also suggestive of benign tumor. In fact, benign Phyllodes tumor is often confused with fibroadenoma on USG. The nodes all have normal morphology and have preserved fatty hilum so they are probably not involved by tumor.
Hence the treatment should be simple excision of the tumor and submitting it for biopsy. It will suffice for treatment as well as confirmation of final diagnosis.
Hope this helps. I will be available for further follow up.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Dr. Indranil for your quick reply.
I just had appointment with a General Surgeon, he advised me to wait few months since the tumor is completely benign and its too small and he couldn't feel it in my breast.
I met 7 doctors before, none of the felt a lump by physical examination. It only shows on ultrasounds imaging.
I would like to hear your opinion regarding this matter.
Also, I would appreciated it if you answer this question:
What are the risks of not having Phyllodes tumor removed?, for months, or for lifetime under clinical supervision if the tumor stays under 3cm.
Thanks in advance.
I just had appointment with a General Surgeon, he advised me to wait few months since the tumor is completely benign and its too small and he couldn't feel it in my breast.
I met 7 doctors before, none of the felt a lump by physical examination. It only shows on ultrasounds imaging.
I would like to hear your opinion regarding this matter.
Also, I would appreciated it if you answer this question:
What are the risks of not having Phyllodes tumor removed?, for months, or for lifetime under clinical supervision if the tumor stays under 3cm.
Thanks in advance.
Brief Answer:
surgery is recomended
Detailed Answer:
I am afraid that surgical excision is the standard treatment. There is no reliable data on what would happen if a series of women with phyllodes were only observed without surgery. because such study will not be possible to conduct.
There is a definite risk of progression to malignant phyllodes or rapid growth.
The following link is a nice review on phyllodes. You may go through it
http://pmj.bmj.com/content/77/909/428.full
Regards
surgery is recomended
Detailed Answer:
I am afraid that surgical excision is the standard treatment. There is no reliable data on what would happen if a series of women with phyllodes were only observed without surgery. because such study will not be possible to conduct.
There is a definite risk of progression to malignant phyllodes or rapid growth.
The following link is a nice review on phyllodes. You may go through it
http://pmj.bmj.com/content/77/909/428.full
Regards
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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