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Introduction: Axillary lymph node (ALN) metastasis from an occult breast cancer is a rare presentation and can be a diagnostic and therapeutic challenge. After ruling out the other sites of malignancy by metastatic workup, mastectomy and axillary clearance or breast conservation surgery should be carried out with appropriate adjuvant therapy.
Objective: Rare occurrence and controversies in investigations and recommended treatment justify reporting our case.
Method: Report of a rare case and literature review.
Results: We report a case of 42 years old woman presenting with right sided axillary mass for last four months. On examination she had a 3x4 cm. mass in the right axilla, both breasts were normal. General physical and systemic examinations were within normal limits. Fine needle aspiration cytology (FNAC) of the right axillary mass showed metastatic adenocarcinoma, rest of the investigations including chest X-Ray, ultrasound of the abdomen, mammogram and MRI of the breasts were normal. She was offered mastectomy and axillary clearance followed by adjuvant chemo-radiation and hormone therapy. Histopathological examinations of the axillary lymph nodes reveled infiltrating ductal carcinoma and positive hormonal receptor status however, mastectomy specimen failed to reveal any carcinoma. She did not have evidence of any recurrence after 3 years of follow-up.
Conclusions: All isolated ALN metastasis should be considered as occult primary breast cancer unless otherwise prove.
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Author(s): D K Das Teo ZC U Choudhury
Occult breast cancer, Axillary nodal metastasis