Title:Infiltrating Metastatic Ductal Carcinoma Initially Presenting as Axillary Lymph
Node Metastases Diagnosed with PET/CT and MRI: Case Report and Brief
Review of Occult Breast Carcinoma
Volume: 20
Author(s): Nicolas-de-Jesus Sanchez-Casas, Leslie-Marisol Gonzalez-Hermosillo, Abril-Carolina Mendoza-Lopez, Elda-Lizeth Nava-Flores and Ernesto Roldan-Valadez*
Affiliation:
- Department of Research, Hospital General de Mexico, Mexico City 06720, Mexico
- Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119992, Russia
Keywords:
Case report, Occult breast cancer, Breast imaging, Metastasis, Axillary node, Mammography.
Abstract:
Introduction:
The concept of occult breast carcinoma (OBC) was first described in 1907 by Halsted, who described this type of breast cancer to arise from small,
undetectable tumours in the breast that had already metastasized to the lymph nodes. Although the breast is the most likely site for the primary
tumour, non-palpable breast cancer presenting as an axillary metastasis has been reported, but with a low frequency of less than 0.5% of all breast
cancers. OBC represents a complex diagnostic and therapeutic dilemma. Considering its rarity, clinicopathological information is still limited.
Case Report:
A 44-year-old patient presented to the emergency room with an extensive axillary mass as the first manifestation. Conventional evaluation of the
breast with mammography and ultrasound was unremarkable. However, a breast MRI confirmed the presence of conglomerate axillary nodes. A
supplementary whole-body PET-CT established the axillary conglomerate with a malignant behaviour with SUVmax of 19.3. The primary tumour
was not detected in the breast tissue of the patient, confirming the diagnosis of OBC. Immunohistochemical results showed positive receptors for
estrogen and progesterone.
Conclusion:
Although OBC is a rare diagnosis, its existence is a possibility in a patient with breast cancer. Mammography and breast ultrasound with
unremarkable findings but with high clinical suspicion should be supplemented with additional imaging methods, such as MRI and PET-CT,
emphasizing the appropriate pre-treatment evaluation.
