POSITRON-EMISSION-TOMOGRAPHY IN DIAGNOSIS OF OCCULT ADENOCARCINOMA OFTHE BREAST

Occult adenocarcinoma with clinically apparent axillary lymphadenopath y represents a challenging surgical problem. Mammography is frequently unable to identify a primary breast carcinoma, and extramammary sourc es are common and equally difficult to identify. This may leave the cl inician and patient with a conundrum of whether to proceed with ''blin d'' mastectomy. A 35-year-old white female presented with axillary ade nopathy and a normal breast physical exam. Mammography was unable to d emonstrate a specific tumor. Excisional biopsy of the axillary lymph n ode demonstrated metastatic adenocarcinoma. Positron emission tomograp hy showed increased uptake in the breast and the axilla, consistent wi th breast carcinoma and axillary metastases. The patient underwent mod ified radical mastectomy and pathologic review of the specimen proved infiltrating ductal carcinoma in the breast with metastatic nodes. Pos itron emission tomography may be helpful in localizing occult carcinom a of the breast that presents with metastatic lymph nodes and in exclu ding other potential primaries.