PMC7300243_01
Mediolateral oblique mammogram.. A lobulated circumscribed high-density mass of the left axilla (arrows).
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A mediolateral oblique mammography (MMG) view indicated a lobulated circumscribed high-density mass, up to 8.0 cm in diameter, on the left axilla (Fig. 1).
Ultrasound.. Left: Lymphangioma consisting of multiple cysts and septa.. Right: Color Doppler imaging indicating well flows in the walls and septa but not in the internal cysts.
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Obvious flows in the walls and septa were observed on color Doppler with no flows in the cystic spaces (Fig. 2).
Magnetic resonance imaging (MRI).. Left: High-intensity MRI of internal spaces on the T2-weighted image.. Right: Enhancement of wells, surrounding walls, and internal septa on the T1-weighted dynamic image.
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Magnetic resonance imaging (MRI) indicated that the internal spaces showed a high intensity on the T2-weighted imaging, while the surrounding walls and internal septa demonstrated a high intensity on the T1-weighted dynamic imaging (Fig. 3).
Intraoperative findings.. Injection of ICG under the left areola.. Left top: marking the lymphatic vessel and tumor with the naked eye.. Right top: lymphatic vessel flowing into the tumor, visible with PDE.. Left bottom: tumor removal with the naked eye.. Right bottom: the tumor itself also glowing, visible with PDE.
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The fluorescent light indicated that only one lymphatic vessel was flowing into the tumor, while the tumor itself was glowing (Fig. 4).
Macroscopic cut surface and histological findings.. Top: a multicystic tumor, 6.5 x 2.5 cm in size, surrounding the fat tissue.. Left bottom: cystic dilations lined by endothelia and surrounding fibrous and adipose tissue (40x original H&E magnification).. Right bottom: endothelia positive for podoplanin (D2-40), a marker of lymphatic vessel (200x original magnification).
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Meanwhile, the endothelia were positive for podoplanin (D2-40), a marker of lymphatic vessels (Fig. 5).