Occult Breast Cancer Presenting as Isolated Axillary Lymphadenopathy: A Case Report with MRI–Pathology Correlation

Authors

Wen H. Luo Rowan-Virtua School of Osteopathic Medicine, NJ 08084
Eleni Papadopoulos Rowan-Virtua School of Osteopathic Medicine, NJ 08084
Jared Garfinkle Rowan-Virtua School of Osteopathic Medicine, NJ 08084
Robert Martin DO Department of Radiology, Temple University Hospital, PA 19140
Chandni Bhimani DO Atlantic Medical Imaging, 1450 E Chestnut Ave, NJ 08361

DOI:

Abstract

Occult breast cancer is a rare presentation of invasive ductal carcinoma in which axillary lymph node metastasis is identified without a detectable breast lesion on mammography or ultrasound. We report a case of a 57-year-old woman recalled from screening mammography for bilateral breast asymmetries that resolved on diagnostic compression views. Targeted ultrasound of the axillary revealed a solitary lymph node with progressive cortical thickening. Core needle biopsy demonstrated metastatic carcinoma, consistent with mammary origin. Breast MRI subsequently localized enhancing foci, confirmed as invasive ductal carcinoma. This case highlights the diagnostic value of contrast-enhanced breast MRI in identifying otherwise occult primary breast tumors and correlation of imaging and histopathologic findings in establishing a definitive diagnosis in clinical occult presentations.

(Left) Bilateral Cranialcaudal (CC) projections of screening mammography and (Right) Bilateral Mediolateral Oblique (MLO) Projection of screening mammography demonstrating heterogenous dense fibroglandular tissue without suspicious masses, calcification, or architectural distortions. Findings are consistent with BI-RADS 1 (negative screening study) prior to the discovery of isolated axillary lymphadenopathy. Technique: Full-field 2D digital mammography with standard CC and MLO projections

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Published

2026-06-15

Issue

2026: Articles in Press

Section

Breast Imaging

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