Decrease in the Size of Fat-Enlarged Axillary Lymph Nodes and Serum Lipids after Bariatric Surgery

Figures

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  Figure 1. A non-metastatic fat-infiltrated axillary lymph node measuring 34 mm in a 67-year-old female with node-positive right breast cancer. Enlarged fatty hilum (double arrows) and thin peripheral cortex (arrowheads) are visualized on a right breast medio-lateral oblique mammogram (A), and on a sagittal contrast-enhanced right breast MRI (B). Axial breast MRI confirms that the expanded fatty hilum within the fat-infiltrated lymph node (double arrows) is composed of fat that is hyper-intense on the pre-fat-saturated sequence (C) and hypo-intense on the fat-saturated sequence (D). The fat signal within the lymph node hilum on the pre- and post-fat-saturated sequences is similar to the fat within the breast and axilla and is different from the peripheral thin lymph node cortex (arrowhead) and adjacent chest wall muscles (thin arrows). The histology of a non-metastatic sentinel node obtained at the time of breast cancer surgery confirms the extensive fatty expansion of the lymph node hilum (double arrow) with a slender rim of lymph node tissue retained at the periphery (arrowhead) (H&E, 1× magnification) (E). Sheets of adipocytes are seen infiltrating into and replacing the lymphocytes at a…

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  Figure 2. Normal right axillary lymph nodes, the largest measuring 13 mm, in a 62-year-old female with node negative right breast cancer. Normal nodes are visualized within the axilla on a right breast medio-lateral oblique mammogram (A), and on a sagittal contrast-enhanced right breast MRI (B). The histology of a sentinel node obtained at the time of breast cancer surgery confirms normal lymph node morphology with minimal fat. Rare patches of adipocytes are present; however, the lymph node architecture and cortical thickness are largely preserved (H&E, 1× magnification) (C). A single adipocyte is pictured within a background of lymphocytes and small capillaries (H&E, 20× magnification) (D).

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  Figure 3. Left medio-lateral oblique mammogram before ((A), 2016) and after ((B), 2019) bariatric surgery. FIN (black dotted line) changed in size from 24.4 mm to 15.9 mm corresponding to a weight loss of 24.2 kgs. Normal lymph nodes for comparison ((A,B), red arrows). There is an associated decrease in the size of the right breast due to marked weight loss and decreased breast adipose tissue.