Multiple Lymph Node and Bone Metastases From An Occult Breast Cancer: A Case Report

Year 2022, Volume: 4 Issue: 4, 190 - 194, 29.10.2022

Hasan Sözel , Halil Göksel Güzel

https://doi.org/10.46310/tjim.991565

Abstract

Cancer of unknown primary is defined as cancer with an unknown primary origin. Occult breast cancer (OBC) is a rare diagnosis in which physical examination, imaging methods, and even surgical procedures are insufficient to put on a primary tumoral site in the breasts. This definition leads to only 0.3-1% of all breast cancer cases. The diagnosis of OBC is usually obtained with an axillary lymph node biopsy. A 52-year-old female presented with right arm weakness and a neck lump. On the physical examination, multiple masses were palpated at the right axillary, right supraclavicular, and anterior cervical areas. Mammography, breast ultrasonography, breast magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) scan could not show a suspicious tumoral area as the primary origin. 18-FDG PET scan put on the massive tumoral burden at multiple bones and lymph nodes, but there were no lesions to suspect as the tumoral origin. Finally, the supraclavicular lymph node biopsy result has revealed the diagnosis; hormone receptor-positive and C-erbB2 positive occult breast cancer. Cervical lymph node metastasis is also a scarce condition for breast cancer. The lymphatic drainage pathway is not clear in explaining the breast cancer involvement of the cervical.

Keywords

Cancer of unknown primary, Breast cancer, Occult cancer, Metastases

References

• Douvetzemis SE. Management of occult breast cancer with axillary involvement. Hell J Surg. 2018; 90(1):33-5. doi: 10.1007/s13126-018-0432-8.
• Chen S. Survival benefit of neck dissection for patients with breast cancer with supraclavicular lymph node metastasis. J Clin Oncol. 2010 May 20;28(15-suppl):1069. doi: 10.1200/jco.2010.28.15_suppl.1069.
• Fan Y, Xu B, Liao Y, Yao S, Sun Y. A retrospective study of metachronous and synchronous ipsilateral supraclavicular lymph node metastases in breast cancer patients. Breast. 2010 Oct;19(5):365-9. doi: 10.1016/j.breast.2010.03.022.
• Mann RM, Balleyguier C, Baltzer PA, Bick U, Colin C, Cornford E, Evans A, Fallenberg E, Forrai G, Fuchsjäger MH, Gilbert FJ, Helbich TH, Heywang-Köbrunner SH, Camps-Herrero J, Kuhl CK, Martincich L, Pediconi F, Panizza P, Pina LJ, Pijnappel RM, Pinker-Domenig K, Skaane P, Sardanelli F; European Society of Breast Imaging (EUSOBI), with language review by Europa Donna–The European Breast Cancer Coalition. Breast MRI: EUSOBI recommendations for women’s information. Eur Radiol. 2015 Dec;25(12):3669-78. doi: 10.1007/s00330-015-3807-z.
• Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, Helbich T, Heywang-Köbrunner SH, Kaiser WA, Kerin MJ, Mansel RE, Marotti L, Martincich L, Mauriac L, Meijers-Heijboer H, Orecchia R, Panizza P, Ponti A, Purushotham AD, Regitnig P, Del Turco MR, Thibault F, Wilson R. Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer. 2010 May;46(8):1296-316. doi: 10.1016/j.ejca.2010.02.015.
• de Bresser J, de Vos B, van der Ent F, Hulsewé K. Breast MRI in clinically and mammographically occult breast cancer presenting with an axillary metastasis: a systematic review. Eur J Surg Oncol. 2010 Feb;36(2):114-9. doi: 10.1016/j.ejso.2009.09.007.
• Kori SH, Foley KM, Posner JB. Brachial plexus lesions in patients with cancer: 100 cases. Neurology. 1981 Jan;31(1):45-50. doi: 10.1212/wnl.31.1.45.
• Kichari JR, Hussain SM, Den Hollander JC, Krestin GP. MR imaging of the brachial plexus: current imaging sequences, normal findings, and findings in a spectrum of focal lesions with MR-pathologic correlation. Curr Probl Diagn Radiol. 2003 Mar-Apr;32(2):88-101. doi: 10.1067/mdr.2003.12007.
• Bhatia SK, Saclarides TJ, Witt TR, Bonomi PD, Anderson KM, Economou SG. Hormone receptor studies in axillary metastases from occult breast cancers. Cancer. 1987 Mar 15;59(6):1170-2. doi: 10.1002/1097-0142(19870315)59:6<1170::aid-cncr2820590623>3.0.co;2-2.
• Grundfest S, Steiger E, Sebek B. Metastatic axillary adenopathy. Use of estrogen receptor protein as an aid in diagnosis. Arch Surg. 1978 Sep;113(9):1108-9. doi: 11.0.1001/archsurg.1978.01370210090015.
• Haupt HM, Rosen PP, Kinne DW. Breast carcinoma presenting with axillary lymph node metastases. An analysis of specific histopathologic features. Am J Surg Pathol. 1985 Mar;9(3):165-75. doi: 10.1097/00000478-198503000-00001.