Surgical management of unusual presentation of axillary lymphoma: a case-based approach

Abstract

Axillary lymphadenopathy has a broad differential, from benign causes to malignancies like lymphoma. Hodgkin’s lymphoma (HL), a hematologic cancer, may present atypically, complicating diagnosis. This case highlights a rare presentation of HL, stressing the value of surgical excision biopsy for definitive diagnosis. A 32-year-old female presented with a gradually enlarging, painless right axillary mass (5×5 cm) over six months, accompanied by B symptoms. Examination revealed firm, nodular lymphadenopathy localized to right axilla. Imaging (USG and HRCT) suggested malignancy; however, FNAC was inconclusive due to inadequate architecture for Reed-Sternberg (RS) cell identification. Excision biopsy confirmed HL (Nodular sclerosis subtype). Immunohistochemistry (CD15 and CD30 positive) supported the diagnosis. Under general anaesthesia, complete excision was achieved via a transverse axillary crease incision, preserving neurovascular structures. Histopathology confirmed RS cells, establishing HL diagnosis. This case emphasizes diagnostic and therapeutic challenge of atypical axillary lymphadenopathy. FNAC limitations in lymphoma necessitate excisional biopsy as diagnostic gold standard. Integration of clinical, radiological, and pathological findings is vital for accurate diagnosis and management. This case demonstrates essential role of excisional biopsy in diagnosing atypical HL. Complete surgical removal enabled histopathological and immunohistochemical confirmation. Early diagnosis and a multidisciplinary strategy are key to better outcomes.