Lumps in the Armpit: Causes, Diagnosis, and Treatment

There is a hard lump in the armpit?

Hello Dr.
Chen,
I discovered a hard lump in my left armpit in early April of this year while touching it accidentally (it appears as a horizontal strip along the fold of the armpit).
I can only feel it when I raise my arm; there are no abnormalities when my arm is hanging down, and the skin color appears normal.
Due to the severe pandemic situation and my COVID-19 diagnosis in mid-May, I continued to monitor it until my appointment with the breast surgeon on July 25.
During this time, the lump did not increase in size.
The breast surgeon, upon initial examination, said it did not seem serious and suggested it might be accessory breast tissue.
They also asked if I had received all my vaccinations in my left arm and prescribed a week’s supply of Unasyn, Broen-C, Nolidin tablets, and a tube of Teiria gel for me to take and apply at home.
At my follow-up appointment the following week, the lump in my armpit had changed from its original elongated shape to a more centralized lump.
The doctor performed an ultrasound on the lump in my armpit and stated that the ultrasound showed no abnormalities, with no tumors or foreign bodies detected, suggesting it is likely just a case of lymphadenopathy.
They prescribed the same medications for me to take home and advised me to simply monitor the lump for any sudden increase in size or pain, and to seek medical attention if any abnormalities arise.
Dr.
Chen, should I return for check-ups every three months, or is self-monitoring sufficient? Would further imaging, such as a mammogram, be necessary, or should the lump be surgically removed? Additionally, is it possible for lymph nodes to remain enlarged for an extended period without resolving? I appreciate your insights on these matters.
Thank you, Dr.
Chen.

Karen, 40~49 year old female. Ask Date: 2022/08/07

Dr. Chen Bingze reply Surgery

Hello, if you have seen a breast surgeon and had an ultrasound, you can feel more reassured because if there are abnormal lymph nodes in the armpit, the ultrasound can detect them.
If everything is safe, it is certainly reasonable to follow up with mammograms every three months for the physician to assess whether there is a need for direct excision of the lump in the armpit.
However, if the ultrasound results are normal, then it may not be necessary.
Generally, if there is lymphadenopathy, it tends to reduce somewhat, but it may not completely resolve.
Do you understand this response?

Reply Date: 2022/08/07

More Info

Understanding lumps in the armpit can be a source of concern for many individuals, especially when they are discovered unexpectedly. In your case, the lump you found in your left armpit, which has been assessed by a breast surgeon and evaluated through ultrasound, appears to be a benign condition, likely related to lymph node enlargement or possibly accessory breast tissue (supernumerary breast tissue).
Lumps in the armpit can arise from various causes, including:
1. Lymphadenopathy: This is the most common reason for a lump in the armpit. Lymph nodes can become enlarged due to infections, inflammation, or malignancies. In your case, the ultrasound did not show any tumors or foreign objects, which is reassuring. The fact that the lump has not changed significantly in size is also a positive sign.

2. Accessory Breast Tissue: As your doctor suggested, this can occur in some individuals where additional breast tissue develops in areas such as the armpit. This is usually harmless and does not require treatment unless it causes discomfort.

3. Infections: Conditions such as abscesses or infections can lead to swollen lymph nodes. However, since you have been treated with antibiotics and the lump has not changed, this is less likely.

4. Cysts or Lipomas: These are benign growths that can occur in the soft tissue. They are generally not harmful and can be monitored.

Regarding your follow-up care, the recommendation to observe the lump for any changes is appropriate. If the lump remains stable and asymptomatic (not painful or tender), you may not need to return for frequent check-ups. However, it is essential to be vigilant and monitor for any changes in size, shape, or associated symptoms such as pain or redness. If any of these occur, you should seek medical attention promptly.

As for the frequency of follow-up visits, it largely depends on your comfort level and the advice of your healthcare provider. If you feel anxious about the lump or if there are any changes, it may be beneficial to have a follow-up appointment every three months for reassurance. Otherwise, self-monitoring with a plan to return if there are any changes is a reasonable approach.

In terms of further imaging, such as mammography or MRI, these are typically reserved for cases where there is a suspicion of malignancy or if the lump changes significantly. Since your ultrasound did not reveal any concerning features, additional imaging may not be necessary at this time.

Lastly, regarding the persistence of lymphadenopathy, it is possible for lymph nodes to remain enlarged for an extended period, especially if they were reactive to a previous infection or inflammation. If the lump remains stable and there are no other concerning symptoms, this is generally not a cause for alarm.

In summary, continue to monitor the lump and maintain open communication with your healthcare provider. If you have any concerns or if the lump changes, do not hesitate to seek further evaluation. Your health and peace of mind are paramount, and it is always better to err on the side of caution.

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