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February 1997

Pathological Case of the Month

Arch Pediatr Adolesc Med. 1997;151(2):205-206. doi:10.1001/archpedi.1997.02170390095019

A 9-YEAR-OLD girl was referred to a pediatric surgeon for what was thought to be persistent left axillary adenopathy of 1 month's duration. The child had received 2 consecutive 10-day courses of antibiotic therapy with no change in the axillary mass. There was no known exposure to tuberculosis; however, the patient had been exposed to many farm animals, including several kittens. The patient had no constitutional symptoms.

Findings on physical examination disclosed a firm, discrete, nontender, mobile mass palpable in the left anterior axillary fold measuring 2 cm in diameter. No generalized lymphadenopathy, scratches, or bites were present. The child was referred for fine-needle aspiration (Figure 1) and, subsequently, excision of the mass (Figure 2).

Diagnosis and Discussion  Granular Cell TumorThe differential diagnosis of an axillary mass in a child includes enlarged lymph nodes due to infectious causes such as pyogenic bacteria, cat scratch disease and mycobacteria, and lymphoma.