Differential Diagnosis for a 38-year-old Female with Multiple Left Axillary Lymph Nodes
- Single Most Likely Diagnosis
- Breast cancer: Given the presence of multiple left axillary lymph nodes, the largest measuring 4.7 cm, and the initial suspicion based on clinical presentation, breast cancer is a highly plausible diagnosis. The negative mammogram and diagnostic ultrasound do not entirely rule out breast cancer, especially in younger women or those with dense breast tissue, where mammography sensitivity is reduced.
- Other Likely Diagnoses
- Lymphoma: The enlargement of lymph nodes, particularly to such a significant size, raises the suspicion of lymphoma. Both Hodgkin and non-Hodgkin lymphoma can present with lymphadenopathy, and axillary lymph nodes can be involved.
- Metastatic disease from another primary site: Although less common, it's possible that the lymphadenopathy is due to metastasis from a cancer originating in a different part of the body.
- Do Not Miss Diagnoses
- Tuberculosis (TB): TB can cause significant lymphadenopathy and, although less common in some regions, is a critical diagnosis not to miss due to its public health implications and the need for specific treatment.
- Sarcoidosis: This autoimmune disease can cause lymphadenopathy among other symptoms and, while not immediately life-threatening, requires appropriate diagnosis and management to prevent long-term complications.
- Cat-scratch disease: Caused by Bartonella henselae, this infection can lead to lymphadenopathy, typically following a cat scratch or bite. It's usually self-limiting but can be treated with antibiotics if necessary.
- Rare Diagnoses
- Castleman disease: A rare disorder that involves an overgrowth of cells in the lymphatic system, which can cause lymphadenopathy.
- Kikuchi-Fujimoto disease: A rare, self-limiting condition that causes lymphadenopathy, typically in young women, and is often diagnosed after lymph node biopsy.
- Kimura disease: A rare, chronic inflammatory disorder that can cause lymphadenopathy and eosinophilia, more commonly seen in Asian males but can occur in females as well.
Each of these diagnoses has a different set of implications for treatment and prognosis, highlighting the importance of a thorough diagnostic workup, including the scheduled biopsy of the lymph nodes.