AXILLARY METASTASES FROM AN UNKNOWN PRIMA RY-CARCINOMA OF THE BREAST - CASE-REPORT

S. R., a 66-year old woman, was referred to our department because of an axillary mass in the right side. The patient had observed an increa sing, painless swelling in the right axilla for the last two months. I n the region of the right axilla in the middle axillary line an ovoid and solid tumour of 3 cm in diameter, quite well distinguishable, movi ng against the skin and the surrounding tissue, could be palpated. A s ubsequent mammography yielded an unsuspicious visualisation of both br easts and the left axilla. In the right axilla a circular solidificati on was betected, which then turned out on ultrasound examination to be a 2.6-cm diameter axillary lymph node. In the cour I of the lymph nod e extirpation of the right axilla two lymph nodes were dissected with histological evidence of metastatic nodes of a solid tumour, most like ly in accordance with a breast carcinoma. Several immunohistochemical methods had been applied to determine the origin of the tumour cells a nd were thus identified as breast cancer cells. To detect primary caus ative carcinoma, different examinations were performed postoperatively without identifying any cancerous lesions. At least accurate research concerning the history of the patient was required to reexamine the h istologic material of an operation of the right breast in 1989. The hi stological diagnosis of the dissected node of that time had been defin ed as a benign intracanaliculary papilloma in the right side without e vidence of malignancy. The reexamination of the paraffin-embedded mate rial from the operation of the right breast in 1989 revealed a lobular carcinoma of the right breast. The ''occult'' (undetectable) carcinom a of the breast occurs in less than 1% of all breast carcinomas. Thus it represent a rare clinical event and hence no standardised therapy s chemata exist. To confirm the diagnosis of an occult carcinoma of the breast efficient reaxamination of histological material from earlier b reast operations is indicated.