We select three peculiar cases,
of patients with HIV infection,
from our radiology department.The first was a patient with multiple lymph nodes that the only feature suspected is the thick cortex,
that suggested being typical reactive adenopathies.
The second case,
it was about one patient with breast cancer diagnosed and with multiple lymph nodes but some of them had more atypical features that were suspected.
At last case we reported one patient with previous breast cancer,
already treated.
Later one axillary lymph node grow up and it became palpable,
and with different features compared to the others.
These patients were subjected to more investigation,
all of them with ultrasound-guided fine-needle aspiration and cytological analyze that showed both reactive lymph node and metastasis of breast cancer.
CASE REPORTS
CASE 1
55-year-old female patient performing routine screening for breast cancer.
She has HIV positive,
but no previous other important medical history.
The mammography (Figure 7) showed abnormal multiple dense round lymph nodes that have lost their fatty hilum,
but with small size.
The ultrasound (Figure 8) was performed and it showed in fact multiples axillary lymph nodes,
more than is usually seen,
and they have mostly a thick cortex.
Not breast lesion was observed,
however an ultrasound-guided fine-needle aspiration of one axillary adenopathy was performed because it was the first exame with her and we had no confirmation of reactive adenopathies.
In fact,
it was diagnosed with reactive lymphoid hyperplasia.
CASE 2
56-year-old female patient performing routine screening for breast cancer.
She has HIV positive,
and with confirmed breast malignant lesion.
The mammography (Figure 9) showed axillary lymph node with reniform shaped with a fatty hilum.
The ultrasound (Figure 10) showed some axillary lymph with reniform shape,
a fatty hilum and smooth margins preserved,
most of them had a thin cortex but some had a thick cortex and they were considered suspect.
Ultrasound-guided fine-needle aspiration of one axillary adenopathy was performed.
It was diagnosed with a reactional lymphoid hyperplasia.
CASE 3
62-year-old female patient,
asymptomatic,
revealed,
on routine physical examination,
a palpable axillary nodule.
She has HIV positive,
and she had breast malignant lesion treated a few years ago.
The axillary ultrasound study was performed (Figure 11) and it showed one axillary adenopathy with round shape,
loss of central fatty hilum and strongly hypoechoic.
Not suspected breast lesion was observed,
however,
ultrasound-guided fine-needle aspiration was performed.
It was diagnosed with a metastatic cancer.