Primary Intranodal Hemangioma of the Axilla in a 42-Year-Old Woman: A Case Report and Review of the Literature.

Primary intranodal hemangioma (PIH) is an exceptionally rare benign vascular neoplasm. Owing to its clinical and radiological resemblance to metastatic lymphadenopathy, it poses a diagnostic challenge, particularly when encountered in the axillary region. We report a 42-year-old lactating woman who presented with a palpable, enlarging left axillary mass. Mammography and ultrasound identified a heterogeneous complex lesion in the left axilla. Initial ultrasound-guided core needle biopsy revealed thin-walled vascular channels consistent with hemangioma. Subsequent excision of the axillary lymph nodes demonstrated a well-circumscribed medullary vascular proliferation composed of capillary clusters with characteristic hobnail endothelial morphology. Immunohistochemistry showed diffuse positivity for CD31 and CD34, with negativity for HHV-8, confirming the diagnosis. To the best of our knowledge, this is the first reported case of PIH in Kuwait, with fewer than 50 cases documented in the world literature. Unlike the majority of published cases, which are incidental findings during oncological staging, this lesion was detected in a patient with no prior malignancy.  Intranodal hemangioma should be considered in the differential diagnosis of solitary axillary masses, including in otherwise low-risk patients. Definitive diagnosis rests on histopathological and immunohistochemical evaluation, which is indispensable for excluding aggressive vascular neoplasms and ensuring conservative management.