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@#This paper documents the utility of ultrasound-guided tru-cut biopsy in the diagnosis and subsequent management of a case of occult breast carcinoma presenting with multiple distant metastases in the absence of a primary breast lesion. She was initially diagnosed as primary ovarian malignancy with metastatic disease and subsequently underwent transvaginal ultrasound-guided tru-cut biopsy of the right ovarian mass. Histologic and immunohistochemical studies were consistent with a metastatic adenocarcinoma of breast origin. The patient underwent chemotherapy for primary breast carcinoma and has responded well.
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CarcinomaABSTRACT
@#This paper documents the utility of ultrasound-guided tru-cut biopsy in the diagnosis and subsequent management of a case of occult breast carcinoma presenting with multiple distant metastases in the absence of a primary breast lesion. She was initially diagnosed as primary ovarian malignancy with metastatic disease and subsequently underwent transvaginal ultrasound-guided tru-cut biopsy of the right ovarian mass. Histologic and immunohistochemical studies were consistent with a metastatic adenocarcinoma of breast origin. The patient underwent chemotherapy for primary breast carcinoma and has responded well.
Subject(s)
Biopsy , CarcinomaABSTRACT
@#Introduction: Occult primary breast carcinoma (OBC) manifesting as axillary nodal metastasis without an identifiable breast primary is exceptionally rare. It continues to pose a diagnostic challenge to pathologists. Here, we report a case of OBC with emphasis on the usefulness of immunohistochemistry to determine the primary site of tumour. Case Report: A 58-year-old female presented with a 3-cm painless right axillary mass. Extensive radiological investigations that include mammography, ultrasonography of the breasts and positron emission tomography (PET) scan failed to conclude the primary site of the tumour. Histological examination of the lymph node revealed loosely cohesive sheets of poorly differentiated malignant cells, without discernible glandular or squamous differentiation. Immunohistochemically, the malignant cells exhibited diffuse immunoreactivity toward pan-cytokeratin and CK7, while leukocyte common antigen, S100 and CK20 were negative. A second panel of immunomarkers was carried out. The malignant cells expressed breast-specific markers (GATA-3, GCDFP-15 and mammaglobin), and were negative for ER, PR and TTF-1 immunohistochemistry. A diagnosis of OBC was rendered. Discussion: Breast primary must always be considered in the differential diagnosis in patients with sole presentation of axillary lymphadenopathy. The breast-specific immunomarkers play a pivotal role in the diagnosis of ER, PR-negative occult breast cancer.
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Occult breast cancer is a carcinoma discovered by the presence of axillary lymph node metastases without the detection of the primary breast tumor. The incidence of this very rare pathology is 0.3%–1.0%. The limited number of these cases does not allow for the precise management of this rare pathology and often, the breast cancer manifestation can take many years to become obvious. We report the case of a 35-year-old woman who presented to our department for annual breast screening examination, without any symptoms. At the time of visit, there were two right and one left tumefactions; unfixed and palpable. Ultrasonography examination confirmed the lesions to be benign. One year later, a palpable hypoechoic axillary left lesion appeared: a lymph node with doubtful morphology. On cytological examination, a biopsy was performed for the axillary left mass which showed irregular masses of large malignant cells with pleomorphism and mitotic figures that suggested a carcinoma. The management of this case is suggestive for cancer of unknown primary syndrome
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PURPOSE: Few studies for occult breast cancer (OBC) have evaluated the effect of radiotherapy (RT) after mastectomy or axillary lymph node dissection (ALND) with/without breast surgery. Therefore, we investigated clinicopathologic factors of OBC with the impact of postoperative RT to determine its prognostic significance using large population-based data. MATERIALS AND METHODS: We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database from 1983 to 2013. A total of 1,045 eligible patients with OBC were identified. We compared overall survival (OS) using Cox proportional hazards regression with propensity score matching after verifying an imbalance of prognosticators between RT group (n=518) and non-RT group (n=479). RESULTS: Patients with age < 70 (p=0.033), married marital status (p < 0.001), undergoing ALND (p < 0.001), more examined lymph nodes (LNs) (p < 0.001), and more metastatic LNs (p < 0.001) were more likely to receive RT. Multivariate analysis after propensity score matching (n=798) showed that patients treated with RT survived significantly longer than those without RT (5-year OS, 81.5% vs. 78.3%; p=0.014). A significantly prolonged OS was observed when RT was given to patients treated with mastectomy (p=0.033), those treated with ALND (p=0.036), or those with more than seven metastatic LNs (p=0.016). CONCLUSION: RT may offer survival benefit in OBC even after mastectomy or ALND, especially in patients with more than seven metastatic LNs. Further prospective studies are needed to validate these findings.
Subject(s)
Humans , Breast Neoplasms , Breast , Cohort Studies , Epidemiology , Lymph Node Excision , Lymph Nodes , Marital Status , Mastectomy , Multivariate Analysis , Propensity Score , Prospective Studies , Radiotherapy , Retrospective Studies , SEER ProgramABSTRACT
Occult breast cancer is a rare disease with the primary symptom of enlarged ipsilateral axillary lymph node. At present,it is still difficult to diagnose occult breast cancer. The diagnosis is based on the core needle biopsy and following immunohistochemical staining for the enlarged lymph nodes. If the results support,the diagnosis can be confirmed after the exclusion of other primary tumors. The standard treatment of occult breast cancer is still the mastectomy and axillary lymph node dissection. Neoadjuvant chemotherapy is an independent factor affecting the prognosis,which is also recommended before the oper-ation. Chemotherapy,radiotherapy and endocrine therapy could be chosen based on immunohistochemical results after surgical treatment. The prognosis of occult breast cancer is similar to the other types of breast cancer at the same staging.
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Objective To analyze the clinicopathological features and prognosis of patients with occult breast cancer ( OBC) , as well as to explore the best treatment .Methods The clinical data of 72 patients with OBC confirmed by pathology were retrospectively analyzed , while 320 cases with other kind of breast cancer were the control group .Results Axillary mass was the first sign of the 72 patients with OBC.The diagnosis rate of MRI was higher than mammary graphy ( 71.4% vs 53.5%) .The difference had statistical significance (χ2 =11.876, P=0.001) .The characteristics of OBC with axillary lymph node metastasis was mainly moderately or low differenti -ated, usually with diffuse infiltrative cancer cells , flaky, like large Apocrine cells.Compared with the control group, the positive rate of CK7, CK20 and TTF-1 had no statistical differences (χ2 =0.058, P=0.810).The posi-tive rate of ER and PR was 46.7% and 36.7%, lower than the control group (χ2 =4.535, P=0.033).Clinical stage, operating method and the number of lymph node metastasis may be the independent factors influencing prog -nosis.Conclusions Axillary mass is the first symptom of OBC .To combine MRI with immunohistochemistry is helpful in diagnosis and differential diagnosis of the disease .The positive rate of ER and PR for OBC patients is low.Modified radical mastectomy combined with adjuvant therapy may be the better choice .
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O câncer oculto de mama, que representa menos de 1% de todos os casos de câncer de mama, é definido como doença não identificada durante o exame físico do paciente nem por exames de imagem da mama, mas que apresenta linfadenopatia axilar compatível para câncer por meio de exames imuno-histoquímicos. Apenas 1% dos casos de câncer de mama acomete indivíduos do sexo masculino. Além disso, representa menos de 1% de todos os cânceres em homens, e tal o câncer representa menos de 1% de todos os cânceres em homens. Apresentou-se o caso de um homem de 54 anos com câncer de mama oculto apresentando metástase para tecido subcutâneo axilar, apresentado como nódulo em topografia axilar esquerda. Após a exérese da lesão, o paciente foi submetido à adenomastectomia bilateral e linfadenectomia axilar à esquerda, sendo o exame anatomopatológico das peças negativo para neoplasia. O paciente realizou radioterapia complementar e encontra-se em hormonioterapia com tamoxifeno (cinco anos). No momento, encontra-se em seguimento sem evidência de doença em atividade. Concluiu-se que o câncer de mama oculto em homem é raro e, por isso, ainda existem divergências sobre o tratamento definitivo, não devendo nunca se subestimar queixas mamárias.
Occult breast cancer, which represents less than 1% of all the cases of breast cancer, is defined as axillary metastasis without clinically and/or radiologically evident primary tumor, but the axillary metastasis is compatible with cancer through immunohistochemistry examinations. Only 1% of the cases of breast cancer occurs in men, and breast cancer accounts for less than 1% of all cancers in men. The authors presented a case study of a 54 year old man with occult breast cancer presenting axillary metastasis to subcutaneous tissue in the left axillary node topography. After excision, the patient underwent bilateral adenomastectomy and left axillary lymphadenectomy, with the pathologic diagnosis negative for any trace of malignancy. The patient underwent radiotherapy and is on hormone therapy with tamoxifen for five years. At the moment, he lies in tracking without evidence of active disease. It was concluded that occult breast cancer is rare in men and, due to that, there are still disagreements over the definitive treatment that can be done to this disease. Another important point is that breast complaints should never be underestimate in male patients.
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PURPOSE: This study compared the survival outcomes of different treatment methods for the ipsilateral breast of occult breast cancer (OBC) patients with axillary lymph node metastasis. METHODS: A retrospective study was conducted in which forty OBC patients with axillary lymph node metastasis were identified out of 15,029 patients who had been diagnosed with a primary breast cancer at between 1992 and 2010. The patients were categorized into three treatment groups based on ipsilateral breast management: breast-conserving surgery (BCS) (n=17), mastectomy (n=12), and nonsurgical intervention with or without radiation therapy (No surgery with or without radiation therapy [No Op+/-RT]) (n=11). All patients underwent axillary lymph node dissection. Cases were evaluated based on treatment and potential prognostic factors with respect to overall survival (OS) and disease-free survival (DFS). RESULTS: During the follow-up period (median follow-up of 71.5 months), the overall OS and DFS were 76.9% and 74.9%, respectively. The 5-year treatment-specific OS was 72.0% for the BCS group, 74.0% for the mastectomy group, and 87.5% for the No Op+/-RT group (log-rank p=0.49). The 5-year DFS was 70.6% for the BCS group, 66.7% for the mastectomy group, and 90.9% for the No Op+/-RT group (log-rank p=0.36). Recurrence rates for the BCS and No Op+/-RT groups were 5.9% and 18.2%, respectively. Histologic grade and lymph node status were inversely correlated with DFS (log-rank p=0.04 and p<0.01, respectively). CONCLUSION: There was no difference in survival outcomes between the three treatment methods for the ipsilateral breast (mastectomy, BCS, and No Op+/-RT) of OBC patients with axillary lymph node metastasis. A large-scale multicenter study is needed to validate the results from this small retrospective study.
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Humans , Breast Neoplasms , Breast , Disease-Free Survival , Follow-Up Studies , Lymph Node Excision , Lymph Nodes , Mastectomy , Mastectomy, Segmental , Methods , Neoplasm Metastasis , Recurrence , Retrospective StudiesABSTRACT
Objective To evaluate the diagnosis, treatment and prognosis of occult breast cancer(OBC). Methods Clinical data of 12 OBC cases from June 1995 to June 2006 were retrospectively analyzed.Results There were 12 female; the mean age was 52.7 years(39～66). Tumor of all cases was in one of breasts, left(10 cases) or right(2 cases), 4 cases in pro- menostasis, 8 cases in post-menopause, and inci-dence of OBC in all kinds of breast cancer was 0.5% (12/2385). All cases were found because of lump in axillary fossa, the biopsy of 10 showed cases were lymph node adenocarcinoma metastatic, the fine needle aspiration of 2 cases were lymph node adenocarcinoma metastatic. Three cases were positive in the determi-nation of estrogen receptor of lymph node adenocareinoma metastatic. Two cases, suspecting breast cancer,could be found fine calcification in the examination of breast X-ray molybdenum target in 10 cases. Buhra-sound in 11 cases and near infrared ray scan in 10 cases did not detect cancer in breast; chest X-ray and Bultrasound in 10 cases and CT and all over the body bone scan in 5 cases did not found any cancer besides breast. Ten cases used modified radical mastectomy for breast cancer, one case radical mastectomy for breast cancer, one palliative operation. Pathological diagnosis of 9 cases after operation found breast primary le-sion, 6 cases were infiltrated duct cancer, 3 eases were intraductal cancer. All cases received radiotherapy and chemotherapy. Three cases which were positive in the determination of estrogen receptor of lymph node adenocarcinoma metastatic received TAM. Followed-up was made from 3 to 10 years, 11 cases were not found recurrence or metastses, and 5 cases had been living over 5 years. Conclusions OBC is one of rare special breast cancers. The powerful infiltrating capability leads to lump in axillary fessa in prophase and dis-rant metastses. The biopsy and fine needle aspiration would be used for diagnosis. Modified radical mastecto-my for breast cancer is the usual therapy method.
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PURPOSE: Contralateral reduction mammaplasty at the time of breast reconstruction using autogenous tissue gives aesthetically improved results in the patients with mammary hypertrophy or ptosis. It also reduces required flap size for reconstruction and permits discarding zones of poor perfusion, decreasing flap size- related problems such as partial flap loss or fat necrosis. Considering the high rate of bilaterality of breast cancer, it also provides a good opportunity for exploration and occult cancer diagnosis in such high risk group patients. METHODS: We retrospectively reviewed 45 consecutive patients who underwent simultaneous breast reconstruction and contralateral reduction mammaplasty was performed about surgical technique, pathologic diagnosis, and subsequent treatment. RESULTS: Three occult breast cancers were found in 45 patients(6.7%); one was microinvasive, and the other two were invasive carcinomas and their mean diameter was 1.2 cm. One patient underwent subsequent breast conserving mastectomy, adjuvant radiation and chemotherapy. The others underwent only radiation and hormone therapy. They were followed up for 10 to 42 months without evidence of recurrence or metastasis. CONCLUSION: Occult breast cancer diagnosed in reduction mammaplasty specimen will lead to good prognosis due to its early detection. Treatment options depend on pathologic finding, stage, marginal status, and the timing of diagnosis. We recommend adequate markings for orientation and margins, excision with sufficient margin, and confirmation by frozen biopsy for suspected lesions.
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Female , Humans , Biopsy , Breast Neoplasms , Breast , Diagnosis , Drug Therapy , Fat Necrosis , Hypertrophy , Mammaplasty , Mastectomy , Neoplasm Metastasis , Perfusion , Prognosis , Recurrence , Retrospective StudiesABSTRACT
A palpable breast lump is the most frequent symptom of breast cancer. At the same time, metastatic lymph nodes can be palpable in the axilla. Breast cancer can sometimes present as an isolated axillary adenopathy without any clinically detectable breast tumor. The incidence of an occult primary tumor with axillary metastases is very low, 0.4% of the breast cancer patients in the collective data. A metastatic carcinoma found in an axillary node should be treated as a breast cancer, because the breast is the most common primary site and because breast cancer is a curable disease with proper management. Between July 1993 and June 1996, 523 breast cancer patients underwent surgery in Asan Medical Center. Among them, 7 patients (1.3%, 7/523) presented with metastatic axillary lymphadenopathy without clinical evidence of a breast tumor or any other primary tumor. The median age of these 7 patients was 49 years (range 39~62 years). The mean size of palpable lymph nodes was 3.7 cm. A histological diagnosis of metastatic adenocarcinoma was obtained by excision in 5 patients and by fine needle aspiration cytology in 2 cases. The findings of the preoperative mammography was normal in 5 patients showed a dense breast in one patient was suspicious in one patient (14%, 1/7). Preoperative ultrasonography detected a suspicious tumor in two patients (28%, 2/7). The primary treatment was a modified radical mastectomy in 6 patients and an axillary dissection with whole breast radiotherapy in one patient. A breast cancer was found in the mastectomy specimen of 4 of 6 patients (66%): one invasive ductal, one invasive lobular, one DCIS, and one LCIS tumor. No tumor was found in two mastectomy samples.The median number of involved metastatic lymph nodes was 2 (range 1~25). The staging was IIA (TxN1M0, T0N1M0) in 4 patients, IIB (T2N1M0) in 2 patients, and IIIA (TxN2M0) in one patient. Four patients were positive for hormone receptors, 2 were negative, and one was unknown. All the patients were treated with postoperative adjuvant chemotherapy, radiotherapy or hormone therapy; no recurrence has been found in these patients to date. We conclude that axillary metastases without clinical evidence of a primary breast tumor represents a unique clinical entity of breast cancer, and it should be treated as a breast cancer to avoid unnecessary labaratory or radiological efforts to find the primary site.