Figure 3. Intraoperative and gross pathologic images.

(a) Surgical biopsy of the enlarged left axillary lymph node. Placement of a 0 silk suture assists in elevating the lymph node during dissection. An Alexis wound protector (Applied Medical, Rancho Santa Margarita, CA) facilitates exposure and gentle tissue handling. All afferent and efferent lymphatic channels were controlled using surgical clips to avoid postoperative lymphocele formation. (b) Gross surface of the enlarged, firm, tan-red lymph node, measuring 5.2 cm x 3.6 cm x 2.5 cm. (c) The cut surface of the lymph node demonstrated a nodular expansion of uniform tan tissue without hemorrhage or necrosis.