Occult Breast Cancer Presented with Axillary Lymph Node Metastases: A Small Case Series to a Frustrating Medical Issue

Abstract

Occult breast carcinoma (OBC) presenting with axillary metastases and no identifiable breast tumor is a rare entity that can be a diagnostic and therapeutic challenge. Retrospectively, we gathered data from five female patients who presented to us with enlarged axillary nodes. Data collected included age at diagnosis, presenting complaints, imaging studies, surgical findings, histology, treatment, and progress. All patients underwent mammographic examination as well as breast ultrasound with no evidence of disease. In all five cases, there was a positive preoperative biopsy of the affected lymph node for breast adenocarcinoma. All patients were treated with modified radical mastectomy (MRM) except for one case, in which ALND was performed. The histology reports of three patients that underwent MRM revealed no sign of intramammary adenocarcinoma. In two cases, there was history of contralateral breast cancer. Only one patient did not receive perioperative chemotherapy. The disease-free survival ranges between 6 months and 2 years. OBC presenting with axillary metastases is an unusual presentation, and there is not enough evidence to support recommendations regarding the management. For patients with no evidence of metastatic disease, the management can be individualized. There is vast heterogeneity in studies concerning the treatment of OBC.