Occult Primary Breast Cancer Presenting with Ipsilateral Nodal Metastatic Disease

Authors

  • Mark Andrew Rowley Jr MD University of Tennessee Medical Center, Knoxville, USA
  • Ethan Nussio BS University of Tennessee Medical Center, Knoxville, USA
  • Rashad Daker MD University of Tennessee Medical Center, Knoxville, USA

DOI:

https://doi.org/10.3941/jrcr.5651

Abstract

Occult primary breast cancer is a rare form of breast cancer which may present as axillary lymphadenopathy. When axillary lymphadenopathy is identified, further workup including biopsy and imaging should be done to rule out malignancy. Treatment for occult breast cancer typically involves axillary lymph node dissection and ipsilateral mastectomy, with a favorable prognosis. We present the case of a 66-year-old female with past medical history of hemochromatosis who underwent magnetic resonance imaging of the abdomen to assess for iron deposition and was found to have right axillary lymphadenopathy. Breast imaging did not reveal a source for her lymphadenopathy. She then underwent lymph node biopsy, which returned as metastatic carcinoma compatible with primary breast cancer. She underwent right axillary lymph node dissection and completed multiple rounds of chemotherapy. Pathology of the lymph node specimen revealed complete therapeutic response and no further evidence of malignancy.

Diagnostic ultrasound following incidental finding of right axillary lymphadenopathy on MRI of the abdomen. Findings: Multiple level II lymph nodes (BI-RADS category 4), correlating with previous MRI findings. Biopsy of these lymph nodes was recommended for pathology and cytology. Technique: Diagnostic targeted greyscale right axillary ultrasound performed in a dedicated Breast Center.

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Published

2025-04-30

Issue

Vol. 19 No. 4 (2025)

Section

Breast Imaging

License

Copyright (c) 2025 Journal of Radiology Case Reports

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