As far as the doctors were concerned, there was only one explanation for the patient’s swollen lymph nodes and the lumps in her armpits.

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As CNN reports, a 30-year-old Australian woman went to the doctor, concerned about the small lumps that had appeared under her arms. She told doctors the lumps had been there for about two weeks. A body scan revealed more bad news: there were also enlarged lymph nodes in her chest, near her lungs.

As Dr. Christian Bryant, one of the woman’s doctors at Sydney’s Royal Prince Alfred Hospital, told CNN:

“Ninety-nine times out of 100, [this] will be lymphoma.”

As the American Cancer Society reports, lymphomas are cancers that start in the lymph nodes. Swollen lymph nodes are an indication of infection, irritation, and sometimes (though not always) lymphoma.

Doctors removed a lymph node from the woman and discovered that it wasn’t only swollen but had turned black in places. When they looked closely, they understood why.

As they wrote in a report for the Annals of Internal Medicine, the lymph node wasn’t cancerous. Instead, the immune cells were full of black pigment — ink from the woman’s tattoos.

Strangely, the patient had two tattoos, but neither was new. One on her back was about 15 years old. A smaller tattoo on her shoulder was about two-and-a-half years old.

Doctors concluded that the woman’s immune cells were carrying the tattoo ink back to her lymph nodes. There, it was blocked off by a cellular structure that kept the pigment contained. Christian Bryant, co-author of the report, told Today:

“This is a reminder that the immune system is designed to remove foreign material and tattoo pigment is no exception.”

Doctors were unable to explain why it took so long for the woman to develop a reaction to the tattoo ink. The process very likely went on for years, and the pigment reportedly dates back as far as that first tattoo. Dr. Bill Stebbins, a dematologist at Vanderbilt University Medical Center, told CNN:

“The pigment is too large for these cells to eat and digest. That’s why they’re still there many years later.”

This was the first reported case where pigmented lymph nodes also looked like lymphoma on a body scan. While the authors couldn’t say how common the reaction is, it is considered an unusual complication for a tattoo.

However, Dr. Laura Ferris of the University of Pittsburgh told “Today” that the woman’s reaction was another reason to think twice before getting inked:

“This is something we occasionally see. Sometimes people forget there can be medical consequences to having a tattoo.”

While complications and bad reactions from tattoos can be minimized by doing your research beforehand, Ferris points out that it’s still possible to get a reaction years later. That’s why doctors emphasize that tattoos are one more thing you need to disclose to your doctor. As Stebbins told CNN:

“It’s important for physicians to be aware of a tattoo history.”

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