Cases Of Occult Breast Cancer Research Articles

Occult breast cancer presenting as metastatic carcinoma in a right axillary lymph node of a post-menopausal female: A case report and review of literature

Introduction: Occult breast cancer (OBC) is a clinically recognizable metastatic carcinoma from an undetectable primary breast tumor. It is rare and accounts for 0.3–1% of all breast cancers, often presenting with lymph node, bone, or skin metastases. It poses a diagnostic challenge for general surgeons, radiologists, and pathologists. Case Report: We present the case of occult breast cancer in a 62-year-old, post-menopausal, female, Nigerian, presenting with a solitary, painless, right axillary lymph node enlargement without a clinical or radiological evidence of a breast mass; and also review the literature. The diagnosis of metastatic breast carcinoma was made and confirmed on histology and immunohistochemistry analysis of the axillary lymph node. Histological examination of the subsequent right breast mastectomy specimen revealed the presence of infiltrating ductal carcinoma even though no definite mass lesion was seen on gross examination. Conclusion: Occult breast cancer can be a diagnostic challenge and should be excluded in any patient presenting with solitary axillary lymphadenopathy. Immunohistochemistry staining patterns can be a mainstay in resolving the differential diagnoses.

A Case of Occult Breast Cancer Undetected by Imaging

A Case of Occult Breast Cancer Undetected by Imaging

Evaluation of Occult Breast Cancer with Automated Breast Volume Sonography (ABVS)

A new method of automatic breast volume ultrasonography (ABVS) brings out new possibilities for the evaluation of occult breast cancer, missed on X-ray mammography due to dense breast glandular tissue. This is primarily due to the opportunity to assess the 3D format of whole breast by one scan with evaluation of a typical for malignancy spicularity or retraction phenomenon, high quality digital imaging technologies that enhance the visualization of retroareolar area, opportunity to work with the image on the working station, in the absence of the patient, the possibility of obtaining comparable scans and use them to monitor pathological formations. We present our own clinical case of occult breast cancer in a patient with a dense glandular background, demonstrating the possibilities of automatic volume sonography.

A Case of Occult Breast Cancer with Swelling of the Major Pectoral Muscle

A Case of Occult Breast Cancer with Swelling of the Major Pectoral Muscle

Clinical and pathological portraits of axillary presentation breast cancer and effects of preoperative systemic therapy.

There is a lack of investigation into the biological characteristics and preoperative systemic therapy (PST) for occult breast cancer (OBC). For this study, departmental records in Breast Disease Center of Peking University First Hospital from January 2008 to December 2015 were retrospectively reviewed to identify cases of OBC. Eleven cases were included, and all patients were female, with a median age of 56 (range: 29–75) years. The sensitivity of magnetic resonance imaging (MRI) was 100%, and the false positive rate was 33.3%. Based on histologic analysis of the axillary node, 9 (81.8%) cases were grade 3, and 2 (18.2%) cases were grade 2; 4 (36.4%) cases were ≥10% estrogen receptor (ER) positive and 6 (54.5%) human epidermal growth receptor 2 (HER2) positive. Nine cases (81.8%) exhibited over 30% Ki67 expression. PST was performed in 5 of the 11 cases. The lymph node response rate was 100% (5/5), but no complete remission was achieved. In conclusion, aggressive subtypes were predominant among the included cases, and PST should be considered for OBC treatment options.

The Results of Occult Breast Carcinoma Treated with Axillary Node Dissection Only: Five Cases Reports

Herein, we report five cases of occult breast cancer treated with axillary node dissection only, without breast surgery or whole breast radiotherapy. The patients complained of a large, hard mass in the axillary area, although no breast masses were palpable. Biopsy of the axillary mass was performed in each case, and histological examination showed a metastatic carcinoma. No malignant findings were observed by mammography or ultrasonography. Magnetic resonance imaging and systemic examinations revealed no extramammary primary lesions. All patients underwent axillary lymph node dissection without breast surgery, and were administered adjuvant chemotherapy but not whole breast radiation therapy. The median follow-up period was 56 months (range, 15–241 months). The patients were all alive with no evidence of disease at the end of the follow-up period.

Occult Primary Breast Cancer Presenting With Axillary Nodal Metastasis: Report of 3 Cases

Occult primary breast cancer presenting as axillary metastasis is a very rare entity of breast cancer. Diagnosis and treatment management represent a real challenge in the absence of consensual attitude. We report 3 cases of occult breast cancer who presented with metastatic nodule in the axilla. Although histology identified a metastatic adenocarcinoma in the lymph nodes, mammography failed to detect the primary tumor. Immunohistochemistry showed that the biopsied lymph nodes were positive for both estrogen and progesterone receptors in all cases, suggesting the breast as the site of the primary tumor. Breast MRI was normal in addition to thoraco-abdomino-pelvic scan. Axillary dissection was performed with breast conservation followed by ipsilateral breast radiotherapy, then adjuvant chemotherapy. They are currently being treated with tamoxifen without evidence of disease with a median follow up of 8 months. doi: http://dx.doi.org/10.4021/jcgo42w

Occult breast cancer presenting as axillary lymph node metastases: A single-institution experience with a challenging diagnostic and therapeutic dilemma

Background : Occult breast cancer with axillary lymph node metastases but without evidence of primary tumor on clinical examination and conventional imaging is a rare but serious scenario. Due to diagnostic difficulties and prognostic uncertainties, evidence to guide the management of such patients is lacking. Here, we review the cases of occult breast cancer treated at our institution and discuss recent advances in its management. Methods : We searched our database for patients with occult breast cancer operated on between 2002 and 2011. The following data were extracted: clinical presentation; diagnostic work-up; surgical treatment; adjuvant management; and duration of follow-up. Results : Out of 1405 patients operated on for breast cancer, 7 (0.5%) had occult breast cancer. The mean age at diagnosis was 60.5 years. Six patients were postmenopausal. All patients had one or more metastatic axillary lymph nodes but no signs of malignancy at either conventional imaging (mammography and ultrasonography) or clinical examination. Magnetic resonance imaging revealed the primary breast tumor in 1 patient. Histopathology showed positive estrogen receptors in 3 patients. After preoperative staging, neoadjuvant chemotherapy and subsequent mastectomy was performed in 1 patient with N3 disease, primary surgical treatment in 5 patients (4 mastectomies, 1 breast-conserving procedure), and chemotherapy alone in 1 patient. Postoperative management included chemotherapy in 5 patients, endocrine therapy in 2, and radiation therapy in 5. An infiltrating carcinoma was found in 5 mastectomy specimens (4 ductal histotype and 1 lobular histotype). The mean tumor size was 11 mm (range, 7-17). At a mean follow-up of 51 months, 6 patients were disease-free, and 1 patient died of pulmonary embolism. Conclusions : Occult breast cancer poses difficult management issues, especially when estrogen receptor status is negative. No consensus exists on the need for breast surgery in such patients, as recent literature suggests that breast irradiation might be an alternative treatment. Management decisions should be taken on an individual basis with a multidisciplinary approach. Considering the results of this series, we believe that breast surgery should be proposed to patients with occult breast cancer.

潜在性乳癌の2例

潜在性乳癌の2例を経験したので報告する．症例1は56歳女性，左頸部腫瘤の生検で乳癌のリンパ節転移と診断され紹介となった．触診や画像検査で両側乳腺に腫瘤を認めず他の原発巣も認めなかった．cT0cN3M1（LYM）cStageIVと診断し化学療法を施行した．症例2は43歳女性，PET-CTで右腋窩に高集積域を認め紹介，触診や画像検査で両側乳腺に腫瘤を認めず右腋窩腫瘤の針生検で乳癌の腋窩リンパ節転移と診断した．右胸筋温存乳房切除術+腋窩リンパ節郭清を施行した．摘出乳腺に腫瘍は認めず，病理診断はpT0pN2aM0pStageIIIAで術後補助化学療法，放射線照射を行った．ともに無再発生存中である．本症例を含む潜在性乳癌報告例の検討では，原発が乳腺であることの証明に免疫染色（CK7，CK20，GCDFP-15，mammaglobin）が有用で，乳房に対する治療では何らかの局所治療が必要と考えられる．

Diagnosis and treatment of occult breast cancer in 44 cases

To summarize the experience of diagnosis and treatment of occult breast cancer in 44 cases. Clinicopathological data of 44 cases of occult breast cancer initially presenting axillary mass alone treated in our department during Jan 1997 to Dec 2008 were retrospectively analyzed. The 44 patients with occult breast cancer accounted for 0.42% of all breast cancer patients admitted to our hospital and institute in the same period. The surgery included radical mastectomy in 16 cases, modified radical mastectomy in 19 cases, axillary clearance in 1 case, and simple axillary node excision in 8 cases. Follow-up, ranging from 12-132 months, was available in 38 cases. Among 32 cases who underwent mastectomy or axillary clearance, 2 cases died of distant metastases and 3 cases were still alive with local recurrence at the time of analysis. In two out of six cases who refused further surgical treatment received mastectomy 16 months and 41 months after the primary diagnosis of occult breast cancer, respectively. Others were alive without evidence of recurrence or metastases at the time of analysis. Occult breast cancer should be taken into consideration in cases presenting with axillary metastasis of unknown primary origin. The treatment of occult breast cancer should include modified radical mastectomy/radical mastectomy or breast conserving surgery combined with breast irradiation.

Clinical Benefits of Mastectomy on Treatment of Occult Breast Carcinoma Presenting Axillary Metastases

Occult breast carcinoma presenting axillary metastases is uncommon and accounts for less than 1% of newly diagnosed breast carcinoma. However, it continues to be a challenging diagnostic and therapeutic problem. In this study, we analyzed retrospectively on 51 cases of occult breast cancer from 1990 to 2003 in our hospital. All these patients had a palpable axillary nodule, no dominant breast mass, and no abnormal mammograms and breast ultrasonograph. Histological examination of axillary mass revealed metastasis from breast. The positive rate of estrogen receptor, progesterone receptor and the monoclonal antibody M4G3 against human breast cancer showed 62.7%, 66.7%, and 93.1% positive respectively. Among 51 cases, 38 cases received mastectomy whereas 13 cases had no local treatment of the breast. The primary tumors were detected in 28 of 38 cases having mastectomy by pathology. Seventy-seven percent of patients who had no local treatment of the breast had a tumor recurrence, compared with 26% who had a mastectomy. The mean disease-free survival was 23 months in patients who had no local treatment of the breast, compared with 76 months in patients who had mastectomy. Eight of the 13 patients who had no treatment with breast died whereas seven of the 38 who had local treatment died, with a mean follow-up of 73 months. It was found that patients having mastectomy had a better disease-free survival (p < 0.001) and overall survival (p < 0.001) compared with those having no local treatment of the breast. Once the diagnosis of occult breast carcinoma is clarified, an axillary dissection and the local treatment of breast should be carried out.

Two cases of occult breast cancer in which PET-CT was helpful in identifying primary tumors

We report two cases of occult breast cancer in which masses were completely nonpalpable and positron emission tomography-computed tomography (PET-CT) was extremely helpful in identifying the primary tumor. Case 1 involved a 56-year-old woman with enlarged lymph nodes 3 cm in size in the axilla. Based on excisional biopsy, axillary lymph node metastasis of breast cancer was suspected but an obvious primary tumor in the breast was not identifiable on mammography, contrast-enhanced CT, or ultrasonography. Faint accumulation of fluorodeoxyglucose (FDG) was noted only on PET-CT, so the site was considered to be the primary site, and operation was performed. As a result of postoperative pathological examination, ductal carcinoma in-situ (DCIS) was diagnosed. Case 2 involved a 55-year-old woman with enlarged lymph nodes 3 cm in size in the axilla. Based on the excisional biopsy, axillary lymph node metastasis of breast cancer was suspected. In this case as well, an obvious primary tumor was not identifiable with palpation or mammography. On PET-CT, faint accumulation of FDG was noted in the vicinity of the CD regions, or upper and lower outer quadrants. When contrast-enhanced CT and ultrasonography were performed, a faint nodular opacity less than 1 cm in size corresponding to this site was found and diagnosed as the primary site, operation was subsequently performed. Pathologic diagnosis indicated invasive cancer. PET-CT is a helpful option for the diagnosis of occult breast cancer with primary sites that conventional imaging studies have difficulty identifying.

乳房温存治療を選択した潜在性乳癌の3例

乳房温存治療を選択した潜在性乳癌の3例

潜在性乳癌の1例

症例は74歳, 女性。右腋窩部腫瘤を主訴に来院。腫瘤は弾性硬で径約5cm, 可動性は比較的保たれていた。腋窩腫瘤の超音波所見は内部やや不均一なlow echoic massとして描出され腫大したリンパ節と考えられた。乳癌の腋窩リンパ節転移を疑ったが両側乳房に明らかな腫瘤を触知せず, 画像診断上でも腫瘤像や有意な異常所見を認めなかった。穿刺吸引細胞診の結果はClassVで転移性腺癌が疑われた。全身検索を行い原発巣の発見に努めるも確定診断を得ることができず, 潜在性乳癌の右腋窩リンパ節転移を疑った。腫瘍が大きいためneoadjuvantとしてdocetaxel hydrateを投与したところ腫瘍の縮小が認められ, 胸筋温存乳房切除術を施行した。病理では右腋窩リンパ節内に腺癌成分を認めリンパ節への転移性腺癌の診断であった。癌組織においてはHER2タンパク1+, ER (+), PgR (-) であった。

A Case of Occult Breast Cancer With Paraneoplastic Polyneuropathy.

We encountered a very rarc case of occult breast cancer associated with paraneoplastic sensory polyneuropathy. A 59-year-old woman was admitted to our hospital complaining of numbness in all extremities, ataxia of left extremities and a tumor in the left axilla. From the neurological findings, a malignant tumor was suspected. The immunohistochemical analysis of the axillar swollen lymph node revealed metastasis from breast cancer and confirmed the primary lesion. On a preoperative diagnosis of suspected occult breast cancer, left mastectomy and resection of left axillar lymph nodes were performed. Furthermore, immunohistochemical staining of sural nerves and Western blot analysis of the serum of this patient showed the loss of axons and the presence of antineural antibody in the seurm. Immunological response was considered to be the remote effector system between the breast cancer and sensory polyneuropathy in this disorder.

Whole organ subserial section examination of occult breast carcinoma

In mastectomy specimens, the primary foci of occult breast carcinoma were usually examinated by routine histopathological method, but the result was not satisfactory. The detecting rates of primary foci were 50%–56% in China and 45%–75% in some other countries. In this study, whole organ subserial section was performed in 20 cases of occult breast cancer from April, 1988 to February, 1994. Primary foci were found in 16 cases (80%) by microscopic examination. Diameters of 10 foci were less than 1.0 cm with the smallest as 0.3 × 0.1 × 0.1 cm. In addition, occult multiple foci were detected in 5 cases (31.25%), which would be very difficult to be found by routine histopathological examination. ER, PgR and monoclone M4G3 assays were performed for positive lymph nodes to confirm the primary foci to be breast cancer. The possible causes for the failure of detection of the primary foci by whole organ section are discussed.

TWO CASES OF OCCULT BREAST CANCER

Two cases of occult breast cancer that we encountered are reported inaddition to the discussion on the literature. Case 1 was a 57-year-old woman who visited our department because she moted masses in the left axillary and supraclavicular fossae. When the mass in the left axillary fossa was examined via biopsy, it was diagnosed as metastatic adenocarcinoma. Because a mammogram showed very small calcification, but a possible malignant tumor in other organs was clinically denied, she was diagnosed as breast occult cancer. This patient underwent extended radical mastectomy of the left breast; the tumor was defined as T0, N3, M0 and stage IIIb. Case 2 was a 64-year-old woman who visited our department with the main complaint of an egg-sized painless mass in the left axillary fossa. Because the mass was diagnosed as metastatic adenocarcinoma via biopsy, her whole body was examined, a nd a mass, measuring about 2cm in diameter, was detected in the left thyroid lobe. While we were thinking of a possibility of breast occult cancer, we undetook operation based on suspected thyroid adenocarcinoma. Because that tumor was found to be benign goiter during operation, total mastectomy was performed at the same time. Her breast tumor was histopathologically defined as medullary tubular carcinoma with infiltration to a very limited extent.