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    Related Topics

    From Lymphatic System

    Tracheobronchial Nodes
    Drain lungs and bronchi.
    Supraclavicular Lymph Nodes
    Located above the clavicle; key in thoracic drainage.
    Peyer’s Patches
    Lymphoid nodules in the small intestine.
    BALT
    Bronchus-associated lymphoid tissue.
    Lymph Nodes
    Small structures that filter lymph and store immune cells.
    Axillary Lymph Nodes
    Drain the upper limbs and chest wall.
    Thoracic Duct
    Main lymphatic duct draining most of the body.
    Parotid Lymph Nodes
    Drain the lateral face and scalp.
    Spleen
    Filters blood and initiates immune response.
    Waldeyer’s Ring
    Ring of lymphoid tissue surrounding the naso- and oropharynx.
    Occipital Lymph Nodes
    Drain the back of the scalp.
    Pretracheal Nodes
    Located anterior to the trachea.
    Lateral Axillary Nodes
    Located along the humerus in the axilla.
    Bronchomediastinal Trunk
    Drains lymph from thoracic organs.
    Appendix
    Lymphoid-rich structure of the large intestine.
    Mesenteric Lymph Nodes
    Drain the intestines and abdominal structures.
    Popliteal Lymph Nodes
    Drain the foot and leg.
    Preaortic Nodes
    Located in front of the aorta.
    Cisterna Chyli
    Dilated sac at the start of the thoracic duct.
    Thymus
    Primary lymphoid organ for T-cell maturation.
    Anterior Mediastinal Nodes
    Drain anterior thoracic structures.
    Iliac Lymph Nodes
    Include external, internal, and common iliac nodes.
    NALT
    Nasal-associated lymphoid tissue.
    Red Bone Marrow
    Produces lymphocytes; site of B-cell maturation.
    Lumbar Trunk
    Drains lower limbs and pelvic organs.

    Central Axillary Nodes

    Reviewed by our medical team

    Located centrally in the armpit.

    1. Overview

    The central axillary lymph nodes are a group of deeply situated nodes within the axilla (armpit) that receive lymph from multiple other axillary nodal groups. Acting as a convergence point in the axillary lymphatic system, they are critical for filtering lymph from the upper limb, breast, and thoracic wall. These nodes play a central role in immune defense, fluid balance, and are a key focus in breast cancer staging and surgical procedures.

    2. Location

    Central axillary nodes are located centrally within the axilla, embedded in the adipose tissue near the base of the axilla. Anatomically, they are positioned:

    • Medial to: The axillary vein

    • Posterior to: The pectoralis major and minor muscles

    • Superior to: The anterior, posterior, and lateral axillary node groups

    There are typically 3 to 4 central axillary lymph nodes. They lie deep within the axillary fat and receive afferent lymphatic vessels from the anterior (pectoral), posterior (subscapular), and lateral (humeral) node groups. Their efferent lymphatic vessels drain upward into the apical (subclavicular) axillary nodes.

    3. Structure

    Each central axillary node is an encapsulated, bean-shaped structure composed of organized lymphoid tissue. The node has a typical internal architecture:

    • Cortex: Contains follicles with B lymphocytes involved in humoral immune responses.

    • Paracortex: Rich in T lymphocytes and dendritic cells that mediate cell-mediated immunity.

    • Medulla: Contains plasma cells, macrophages, and medullary sinuses where lymph is further filtered.

    The central node group acts as an intermediary relay point in the lymphatic flow from the peripheral axillary groups toward the apical nodes and central circulation.

    4. Function

    Central axillary lymph nodes play essential roles in regional lymphatic drainage and immune protection. Their major functions include:

    • Filtration: Remove pathogens, debris, and potentially malignant cells from lymph draining from the upper limb, chest wall, and breast.

    • Immune response activation: Serve as sites where lymphocytes are activated in response to antigens.

    • Lymph flow regulation: Channel lymph from peripheral nodes to the apical nodes and ultimately into the subclavian lymphatic trunk.

    5. Physiological Role(s)

    The central axillary nodes play multiple physiological roles that support both immunity and fluid balance:

    • Regional immune defense: Respond to local infections or antigens from the arm, breast, and chest wall.

    • Immunological memory: Help in the generation and storage of memory B and T cells for future immune responses.

    • Lymphatic relay center: Integrate lymphatic drainage from three major nodal groups and prepare it for transfer to apical nodes.

    • Homeostasis: Prevent interstitial fluid accumulation by facilitating its return to the bloodstream via lymphatic circulation.

    6. Clinical Significance

    Breast Cancer Staging

    Central axillary nodes are commonly involved in the spread of breast carcinoma, especially from the lateral and central quadrants of the breast. Their involvement affects staging and treatment planning:

    • Sentinel lymph node biopsy (SLNB): If cancer cells are found in central nodes, it suggests regional nodal spread and may warrant more extensive axillary dissection.

    • Axillary lymph node dissection (ALND): Involves removal of central nodes along with others in cases of confirmed metastasis.

    Positive central node involvement is considered an intermediate level (Level II) in axillary staging.

    Lymphadenopathy

    Enlargement of the central axillary nodes may indicate underlying pathology. Causes include:

    • Infections: Such as cellulitis, mastitis, or upper limb infections.

    • Malignancies: Breast cancer, melanoma, or lymphoma.

    • Systemic inflammatory disorders: Such as lupus or rheumatoid arthritis.

    Postoperative and Surgical Considerations

    During surgeries for breast cancer, care must be taken when removing or biopsying central nodes to avoid complications such as:

    • Lymphedema: Due to disrupted lymphatic drainage of the upper limb.

    • Nerve damage: Especially to the intercostobrachial nerve, resulting in sensory changes to the medial upper arm.

    • Axillary web syndrome (cording): Can occur after central node removal, causing restricted arm movement and tightness.

    Imaging and Diagnosis

    Central axillary nodes are difficult to palpate due to their depth and require imaging for proper assessment:

    • Ultrasound: Often used as the first imaging modality for suspicious axillary findings.

    • MRI or mammography: Can show regional lymph node enlargement in breast cancer evaluation.

    • Biopsy (FNA or core needle): Used for definitive diagnosis when suspicious lymphadenopathy is found.

    Did you know? The lymphatic system helps in removing waste products and toxins from the body.