The Ultrasound Raised Questions. Pathology Answered Them

A young lactating mother noticed a swelling in her left underarm shortly after she stopped breastfeeding a couple of months ago. There was occasional pain, but no fever, cough, night sweats, or unexplained weight loss. Like many women during the postpartum phase, she initially assumed it could be linked to hormonal changes or the natural physical adjustments that happen after breastfeeding ends.

At Star Imaging and Path Lab, ultrasound evaluation revealed multiple enlarged lymph nodes in the left axilla, with the largest measuring nearly 6 cm. The nodes were non necrotic in nature and showed maintained hilum, findings that required further assessment for definitive diagnosis.

Based on the clinical and radiological findings, the consulting clinician advised a USG Guided FNAC for detailed evaluation. The cytopathological evaluation and reporting were performed by Dr. Avni Bhatnagar.

Microscopic examination demonstrated a polymorphous lymphoid cell population comprising immunoblasts, centrocytes, centroblasts, mature lymphocytes, and occasional plasma cells. Interspersed among these were uni, bi, and multinucleated atypical cells showing coarse chromatin, prominent nucleoli, and moderate cytoplasm. Occasional Reed Sternberg-like cells were also identified in a background containing lymphoglandular bodies, eosinophils, histiocytes, neutrophils, and RBCs.

The findings strongly suggested a malignant lymphoproliferative pathology likely Hodgkin Lymphoma that required oncological correlation and further management.

What makes this case important is how quietly the condition presented itself. The patient did not have the symptoms people commonly associate with serious illness. There was no persistent fever, no drenching night sweats, and no major constitutional complaints. The swelling was noticed incidentally after breastfeeding cessation, which is exactly why such findings are often ignored or mistaken for temporary postpartum changes.

In many cases involving enlarged lymph nodes, timely evaluation can significantly influence treatment outcomes. Published data on Hodgkin lymphoma and related lymphoid malignancies continue to show encouraging survival rates, with five year survival approaching 89 percent in several early stage presentations.

This case also highlights the importance of combining radiology with pathology instead of relying on imaging alone. While ultrasound helps assess the structure and characteristics of lymph nodes, pathological examination provides the cellular detail needed for accurate diagnosis.

“Persistent lymph node swelling should always be evaluated carefully, even in young patients without major symptoms. Image guided FNAC helps us study suspicious lymph nodes in a focused and minimally invasive manner, allowing clinicians to proceed with appropriate treatment planning without unnecessary delay.”

- Dr. Avni Bhatnagar (Consultant Pathologist- Star Imaging and Path Lab Limited)

At Star Imaging and Path Lab, integrated imaging and pathology support allows clinicians to correlate radiological findings with microscopic diagnosis under one roof, helping patients receive faster and more informed clinical guidance.

Frequently Asked Questions

Question: What causes swelling in the underarm after breastfeeding?

Answer: Underarm swelling can occur due to hormonal changes, reactive lymph nodes, infection, inflammation, or lymphoid disorders. Persistent swelling should always be medically evaluated.

Question: What is a USG Guided FNAC?

Answer: USG Guided FNAC is a minimally invasive procedure in which ultrasound imaging is used to guide a fine needle into a suspicious lymph node or lesion for microscopic examination.

Question: Are enlarged lymph nodes always dangerous?

Answer: No. Enlarged lymph nodes may occur due to infections or benign reactive conditions, but persistent enlargement requires proper investigation.

Question: Why was pathology needed after ultrasound?

Answer: Ultrasound helps identify the size and characteristics of lymph nodes, while pathology examines the cells themselves to determine the underlying cause.

Question: Can lymphoma occur without fever or weight loss?

Answer: Yes. Some patients may not experience classic symptoms such as fever, night sweats, or weight loss in the initial stages.

Question: When should someone get an underarm swelling checked?

Answer: Any swelling that persists for weeks, enlarges over time, or causes discomfort should be evaluated by a clinician.