Axillary Lumps: What You Need to Know About Your Health

Axillary swelling issues?

Hello Dr.
Chen, I discovered a protrusion in my left armpit around late April.
It has a smooth surface, is elongated, approximately 4×2 cm, and feels somewhat like a muscle; it is soft to the touch and not painful.
I'm not quite sure how long it has been there since I don't usually check that area.
However, due to my concern that it might be something serious, I consulted three doctors (all performed a physical examination).
The first was a family medicine physician who said it was nothing to worry about and advised against frequent touching to avoid inflammation.
The second was a hematologist-oncologist who mentioned that there are many possibilities for the lump, including benign and malignant conditions, but he believed it did not appear to be anything concerning.
He also examined my chest and found no hard masses, but ordered blood tests and a chest X-ray.
After two days of waiting for the blood results, I was still very anxious, and since the second doctor only had one clinic day a week, I went to see another physician in the same department at the same hospital to review the report.
This doctor indicated that everything was normal except for a slightly elevated LDH level (232, with the reference range upper limit at 225), stating that this minor excess could be within acceptable variability.
After the examination, he concluded that it was normal tissue and advised me to monitor it for any growth and to avoid frequent touching to prevent potential inflammation.
Coincidentally, three days before the blood draw (one day before I saw the first family medicine physician), my company conducted a health check that included the same blood tests, and my LDH was 155, with all other results normal.
I would like to ask Dr.
Chen what this issue might be and what I should pay attention to.
Also, why did the LDH levels fluctuate so significantly within a few days? Thank you for your patience in reading this!

Sam, 30~39 year old female. Ask Date: 2022/06/02

Dr. Chen Sirong reply Oncology

Sam / 37 years old / Male
Hello,
1.
What could this issue be and what should I pay attention to?
a: I believe the first physician's response fully addressed your concerns.
I do not have a better answer.

1.1 The family medicine physician indicated that there is nothing to worry about and advised against frequent palpation as it may lead to inflammation.

1.2 The hematologist stated that there are many possibilities for the lump, including benign and malignant conditions, but he does not believe it appears to be anything concerning.
He also examined the chest and found no hard masses, but ordered blood tests and a chest X-ray.

1.3 Another hematologist reviewed the reports and noted that aside from a slightly elevated LDH level (232, with the reference range upper limit at 225), all other results were normal.
He indicated that this slight elevation is within acceptable limits of variability.
After palpation, he assessed it as normal tissue and advised me to monitor it for any changes in size, cautioning against excessive manipulation to avoid potential inflammation.
2.
Why do the values for this item fluctuate so significantly within a few days?
a:
2.1 Different machines may have varying normal value settings.

2.2 Your values will still be considered normal for assessment.

2.3 This value should not be related to your axillary area.

Wishing you peace and joy during the pandemic.

Taoyuan Hospital
Dr.
Chen Sih-Rong

Reply Date: 2022/06/02

More Info

When it comes to understanding axillary lumps, it's essential to approach the situation with both caution and knowledge. From your description, it seems you've already taken significant steps by consulting multiple physicians, which is commendable. The lump you described in your left axilla, measuring approximately 4x2 cm, smooth, soft, and painless, is likely benign, especially since multiple doctors have assessed it and found no alarming signs.

Possible Causes of Axillary Lumps
1. Lymphadenopathy: One of the most common causes of lumps in the axillary region is swollen lymph nodes. This can occur due to infections, inflammation, or even benign conditions. Given that your lump is soft and painless, it may be a reactive lymph node responding to a minor infection or inflammation elsewhere in the body.

2. Lipoma: A lipoma is a benign tumor made of fat tissue. These are typically soft, movable, and painless, which aligns with your description.

3. Cysts: Sebaceous cysts can also form in the axillary area. They are usually benign and can feel soft and movable.

4. Fibroadenoma: Although more common in breast tissue, fibroadenomas can occasionally present in the axillary region. They are benign tumors that feel firm but are generally painless.

5. Malignancy: While the possibility of a malignant lump cannot be entirely ruled out, the characteristics you've described and the assessments from your doctors suggest that this is unlikely.

Understanding Your Blood Test Results
Regarding your blood test results, the LDH (lactate dehydrogenase) level can fluctuate for various reasons. LDH is an enzyme found in almost all body tissues, and its levels can rise due to tissue damage, hemolysis, or even strenuous exercise. The fact that your LDH was slightly elevated at 232, compared to the reference value of 225, may not be clinically significant, especially if it was within normal limits during your company's health check just days prior. Variations in LDH levels can occur due to:
- Physical Activity: If you engaged in strenuous exercise or physical activity before the blood draw, it could elevate LDH levels temporarily.

- Infection or Inflammation: If there was any underlying infection or inflammation, it could also lead to a transient increase in LDH.

Recommendations
1. Observation: Continue to monitor the lump. If it grows, changes in texture, or becomes painful, seek medical attention promptly.

2. Avoid Frequent Manipulation: As advised by your doctors, refrain from frequently touching or manipulating the lump to prevent potential inflammation.

3. Follow-Up: Regular follow-ups with your healthcare provider are essential. If you notice any new symptoms, such as fever, night sweats, or unexplained weight loss, report these to your physician.

4. Healthy Lifestyle: Maintain a healthy lifestyle, including a balanced diet and regular exercise, which can help support your overall health and immune system.

5. Further Testing: If you remain concerned, discuss with your doctor the possibility of further imaging studies, such as an ultrasound, to provide additional information about the lump.

Conclusion
In summary, while the presence of an axillary lump can be concerning, the characteristics you've described and the assessments from your healthcare providers suggest that it is likely benign. Continue to monitor the situation, maintain open communication with your healthcare team, and prioritize your overall health. If you have any further questions or concerns, don't hesitate to reach out to your physician for personalized advice.

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