CONTRALATERAL AXILLARY LYMPH-NODE METASTASIS AS THE FIRST EVIDENCE OFLOCALLY RECURRENT BREAST-CARCINOMA

Background. Carcinoma of the breast infrequently presents initially as axillary adenopathy. In such cases, after biopsy proves the presence of metastatic carcinoma, the primary tumor generally is assumed to be in the ipsilateral breast, despite negative mammographic findings and the lack of a clinically palpable breast mass. Methods. The authors re cently studied a case of a 50-year-old woman in whom recurrent neuroen docrine carcinoma of the breast presented as a contralateral axillary lymph node metastasis. After mastectomy ipsilateral to the metastasis proved negative for tumor, a histologic comparison of the previous con tralateral tumor with that in the lymph node was performed, followed b y biopsy of the clinically and mammographically negative original lump ectomy site. Results. Histologic and immunohistochemical studies prove d that the original, metastatic, and locally recurrent tumors were ide ntical, sharing unusual neuroendocrine features. The patient is curren tly disease free after chemotherapy. Conclusion. Contralateral mammary carcinoma should be considered in the workup of a patient who present s with evidence of an axillary lymph node metastasis. Locally recurren t breast carcinoma may be clinically and mammographically occult. Hist ologic review of prior biopsy material and comparison with current tis sue is essential in proper patient management.