Occult primary breast carcinoma presented as an axillary mass: A Diagnostic Challenge
- Author:
Wong Yin Ping
1
Author Information
1. Department Of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
- Collective Name:Geok Chin Tan; Rohaizak Muhammad; Pathmanathan Rajadurai
- Publication Type:Journal Article
- Keywords:
Occult breast cancer;
axillary metastasis;
diagnostic challenge;
immunohistochemistry
- From:The Malaysian Journal of Pathology
2020;42(1):151-155
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Occult primary breast carcinoma (OBC) manifesting as axillary nodal metastasis without an identifiable breast primary is exceptionally rare. It continues to pose a diagnostic challenge to pathologists. Here, we report a case of OBC with emphasis on the usefulness of immunohistochemistry to determine the primary site of tumour. Case Report: A 58-year-old female presented with a 3-cm painless right axillary mass. Extensive radiological investigations that include mammography, ultrasonography of the breasts and positron emission tomography (PET) scan failed to conclude the primary site of the tumour. Histological examination of the lymph node revealed loosely cohesive sheets of poorly differentiated malignant cells, without discernible glandular or squamous differentiation. Immunohistochemically, the malignant cells exhibited diffuse immunoreactivity toward pan-cytokeratin and CK7, while leukocyte common antigen, S100 and CK20 were negative. A second panel of immunomarkers was carried out. The malignant cells expressed breast-specific markers (GATA-3, GCDFP-15 and mammaglobin), and were negative for ER, PR and TTF-1 immunohistochemistry. A diagnosis of OBC was rendered. Discussion: Breast primary must always be considered in the differential diagnosis in patients with sole presentation of axillary lymphadenopathy. The breast-specific immunomarkers play a pivotal role in the diagnosis of ER, PR-negative occult breast cancer.
- Full text:5.2020my01057.pdf
