ABSTRACT

Metastatic axillary lymph node from occult breast carcinoma poses a difficult and challenging management. It is a rare entity accounting only 0.3-1% cases of all breast cancer. It involves a multidisciplinary discussion and collaboration. Traditionally the treatment consists of mastectomy with axillary lymph node dissection however the practice patterns have steadily changed over the last two to three decades with an emphasized-on breast conservation therapy (BCT). Here we present a 58-year-old lady presented with enlarging right axilla swelling for one month without any breast lump or nipple discharge. Examination revealed 2 mobile right axilla lymph nodes with no palpable breast lump or demonstrable nipple discharge. Routine imaging including mammogram and ultrasound of the breast did not reveal any lesion except suspicious lymph nodes at the right axilla. Cytology of the lymph node showed suspicious of metastatic lesion. Magnetic resonance imaging of the breast also did not reveal any breast lesion. Positron emission tomography and computed tomography (PET CT) was done but did not show uptake to suggest primary lesion except uptake at the right axillary node and right internal mammary node. Excision biopsy of the right axillary node was proven to be metastatic carcinoma in keeping with breast as primary with negative for estrogen and progesterone receptor but c-erB2 positive. Mastectomy with axillary lymph node dissection was done and histopathology report was found to have 2x1 mm, grade 2 tumor in the breast. Patient underwent adjuvant chemotherapy and radiotherapy and currently on trastuzumab and is doing well with no signs of loco regional recurrence or distant metastasis.