Breast Cancer pp 227-234 | Cite as

Axillary Adenopathy as the Initial Presentation of Breast Cancer

  • Shirley Scott
  • Monica Morrow
Part of the Current Clinical Oncology book series (CCO)


Breast cancer presenting as axillary adenopathy without clinical or radiologic breast findings is a rare clinical entity first described by Halsted in 1907 (1). These occult primary cancers are staged as TONI, stage II breast cancer when thorough clinical and radiologic investigations do not reveal the presence of a primary breast tumor. The reported incidence of this phenomenon ranges from 0.3 to 0.8% (2–5). The mean age at presentation is approximately 50 years in most series, which is similar to that of the general breast cancer population (3,5–10). This rare, but well-recognized phenomenon can present both a diagnostic and therapeutic dilemma because other occult malignancies may present as axillary adenopathy, including melanoma and carcinomas of the thyroid, lung, gastrointestinal tract, ovary, and genitourinary tract. However, the most common source of adenocarcinoma in axillary lymph nodes in women is the breast (6,11–14).


Breast Cancer Axillary Lymph Node Breast Magnetic Resonance Imaging Axillary Lymph Node Metastasis Axillary Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Halsted W (1907) The results of radical operations for the cure of carcinoma of the breast. Ann. Surg. 46, 1–18.PubMedCrossRefGoogle Scholar
  2. 2.
    Baron PL, Moore MP, Kinne DW, et al. (1990) Occult breast cancer presenting with axillary metastases: updated management. Arch. Surg. 125, 210.PubMedCrossRefGoogle Scholar
  3. 3.
    Fitts WT, Steiner GC, Enterline HT (1963) Prognosis of occult carcinoma of the breast. Am. J. Surg. 106, 460–463.CrossRefGoogle Scholar
  4. 4.
    Haagensen CD (1971) The diagnosis of breast carcinoma. In: Haagensen CD (ed.) Diseases of the Breast. WB Saunders, Philadelphia, p. 486–488.Google Scholar
  5. 5.
    Owen HW, Dockerty MB, Gray HK (1954) Occult carcinoma of the breast. Surg. Gynecol. Obstet. 98, 302.PubMedGoogle Scholar
  6. 6.
    Copeland EM, McBride CM (1973) Axillary metastases from unknown primary sites. Ann. Surg. 178, 25–28.PubMedGoogle Scholar
  7. 7.
    Haagensen CD (1986) Diseases of the Breast, 3rd ed. WB Saunders, Philadelphia, pp. 548–555.Google Scholar
  8. 8.
    Knapper WH (1991) Management of occult breast cancer presenting as an axillary metastasis. Semin. Surg. Oncol. 7, 311–313.PubMedCrossRefGoogle Scholar
  9. 9.
    Patterson WB (1987) Occult primary tumor with axillary metastases. In: Harris JR, Hellman S, Henderson IC, et al. (eds.) Breast Diseases. JB Lippincott, Philadelphia, pp. 608–613.Google Scholar
  10. 10.
    Westbrook KC, Gallagher HS (1971) Breast cancer presenting as an axillary mass. Am. J. Surg. 122, 607–611.PubMedCrossRefGoogle Scholar
  11. 11.
    Albers CA, Johnson RH, Mansburger AE (1981) The management of patients with metastatic cancer from an unknown primary site. Am. Surg. 47, 162–166.PubMedGoogle Scholar
  12. 12.
    Feigenberg Z, Zer M, Dintsman M (1976) Axillary metastases from an unknown primary source. Israel J. Med. Sci. 12, 1153–1158.PubMedGoogle Scholar
  13. 13.
    Kern WH, Abbott M (1980) The determination of unknown primary sites based upon the histologic appearance of metastases. Surg. Gynecol. Obstet. 151, 73–76.PubMedGoogle Scholar
  14. 14.
    Rosen PP (1980) Axillary lymph node metastases in patients with occult noninvasive breast carcinoma. Cancer 46, 1298–1306.PubMedCrossRefGoogle Scholar
  15. 15.
    Tench DW, Page DL (1991) The unknown primary presenting with axillary lymphadenopathy. In: Bland KI, Copeland EM III (eds.) The Breast: Comprehensive Management of Benign and Malignant Diseases. WB Saunders, Philadelphia, pp. 104I - 1045.Google Scholar
  16. 16.
    Feurman L, Attie JN, Rosenberg B (1962) Carcinoma in axillary lymph nodes as an indicator of breast cancer. Surg. Gynecol. Obstet. 114, 5–8.Google Scholar
  17. 17.
    Kemeny MM, Rivera DE, Teri JJ, et al. (1986) Occult primary adenocarcinoma with axillary metastases. Am. J. Surg. 152, 43–47.PubMedCrossRefGoogle Scholar
  18. 18.
    Patel J, Nemoto T, Rosner D, et al. (1981) Axillary lymph node metastasis from an occult breast cancer. Cancer 47, 2923–2927.PubMedCrossRefGoogle Scholar
  19. 19.
    Haupt HM, Rosen PP, Kinne DW (1985) Breast carcinoma presenting with axillary lymph node metastases. Am. J. Surg. Pathol. 9, 165–175.PubMedCrossRefGoogle Scholar
  20. 20.
    Merson M, Andreola S, Galimberti V, et al. (1992) Breast carcinoma presenting as axillary metastases without evidence of a primary tumor. Cancer 70, 504–508.PubMedCrossRefGoogle Scholar
  21. 21.
    Bhatia SK, Saclarides TJ, Witt Ti, et al. (1987) Hormone receptor studies in axillary metastasis from occult breast cancers. Cancer 59, 1170–1172.PubMedCrossRefGoogle Scholar
  22. 22.
    High RM, Watne AL (1984) The axillary mass in occult breast carcinoma: case reports and overview. Am. Surg. 50, 630–636.PubMedGoogle Scholar
  23. 23.
    Iglehart JD, Ferguson BJ, Shingleton WW, et al. (1982) An ultrastructural analysis of breast carcinoma presenting as isolated axillary adenopathy. Ann. Surg. 196, 8–13.PubMedCrossRefGoogle Scholar
  24. 24.
    Jackson B, Scott-Conner C, Moulder J (1995) Axillary metastasis from occult breast carcinoma: diagnosis and management. Am. Surg. 61, 431–434.PubMedGoogle Scholar
  25. 25.
    Ashikari R, Rosen PP, Urban JA, et al. (1907) Breast cancer presenting as an axillary mass. Ann. Surg. 46, 1–19.CrossRefGoogle Scholar
  26. 26.
    Orel SG, Hochman MG, Schnall MD, et al. (1996) High-resolution MR imaging of the breast: clinical context. Radiographics 16, 1385–1401.PubMedGoogle Scholar
  27. 27.
    Harms SC, Flamig DP, Hesley KL, et al. (1993) Fat suppressed three-dimensional MR imaging of the breast. Radiographics 13, 247–267.PubMedGoogle Scholar
  28. 28.
    Harms SE, Flamig DP, Hesley KL, et al. (1993) MR imaging of the breast with rotating delivery of excitation of resonance: clinical experience with pathologic correlation. Radiology 187, 493–501.PubMedGoogle Scholar
  29. 29.
    Heywang SH, Wolf A, Pruss E, et al. (1989) MR imaging of the breast with Gd-DTPA: use and limitations. Radiology 171, 95–103.PubMedGoogle Scholar
  30. 30.
    Kaiser WA (1992) MRI promises earlier breast cancer diagnosis. Diagn. Imaging Int. Nov/Dec, 44–50.Google Scholar
  31. 31.
    Obdeijn AIM, Kuijpers TJA, van Dijk P, et al. (1996) Limited indications for MR mammography. In: Advances in Magnetic Resonance Imaging. Blackwell Science, London.Google Scholar
  32. 32.
    Pierce WP, Harris SE, Fleming DP, et al. (1991) Three dimensional gadolinium-enhanced MR imaging of the breast: pulse sequence with fat suppression and magnetization transfer contrast. Radiology 181, 757–763.PubMedGoogle Scholar
  33. 33.
    Gilles R, Guinebretiere JM, Lucidarme O, et al. (1994) Nonpalpable breast tumors: diagnosis with contrast-enhanced subtraction dynamic MR imaging. Radiology 191, 625–631.PubMedGoogle Scholar
  34. 34.
    Hulka CA, Smith BL, Sgroi DC, et al. (1995) Benign and malignant breast lesions: differentiation with echo-planar MR imaging. Radiology 197, 33–38.PubMedGoogle Scholar
  35. 35.
    Kaiser WA, Zeitler E (1989) MR imaging of the breast: fast imaging sequences with and without Gd-DTPApreliminary observations. Radiology 170, 681–686.PubMedGoogle Scholar
  36. 36.
    Stomper PC, Herman S, Klippenstein DL, et al. (1995) Suspect breast lesions: findings at dynamic gandoliniumenhanced MR imaging correlated with mammographic and pathologic features. Radiology 197, 387–395.PubMedGoogle Scholar
  37. 37.
    Morris EA, Schwartz LH, Dershaw DD, et al. (1997) MR imaging of the breast in patients with occult primary breast carcinoma. Radiology 205, 437–440.PubMedGoogle Scholar
  38. 38.
    Harms SC, Flamig DP (1994) Staging of breast cancer with MR imaging. Magn. Reson. Imaging Clin. N. Am. 2, 573–584.PubMedGoogle Scholar
  39. 39.
    Davis PL, Julian TB, Staiger M, et al. (1994) Magnetic resonance imaging detection and wire localization of an “occult” breast cancer. Br. Cancer Res. Treat. 32, 327–330.CrossRefGoogle Scholar
  40. 40.
    Porter BA, Smith JP, Borrow JW (1995) MR depiction of occult breast cancer in patients with malignant axillary adenopathy (abstr). Radiology 197, 130.Google Scholar
  41. 41.
    Brenner RJ, Rothman BJ (1997) Detection of primary breast cancer in women with known adenocarcinoma metastatic to the axilla: use of MRI after negative clinical and mammographic examination. J. Magn. Reson. Imaging 7, 1153–1158.PubMedCrossRefGoogle Scholar
  42. 42.
    Tilanus-Linthorst MMA, Obdeijn AIM, Bontenbal M, et al. (1997) MRI in patients with axillary metastases of occult breast carcinoma. Breast Cancer Res. Treat. 44, 179–182.PubMedCrossRefGoogle Scholar
  43. 43.
    Adler LP, Crowe JP, al-Kaisi NK, et al. (1993) Evaluation of breast masses and axillary lymph nodes with [F18] 2-deoxy-2-fluoro-D glucose PET. Radiology 187, 743–750.PubMedGoogle Scholar
  44. 44.
    Avril N, Dose J, Janicke F, et al. (1996) Assessment of axillary lymph node involvement in breast cancer patients with positron emission tomography using radiolabeled 2- (fluorine-18)-fluoro-2-deoxy-D-glucose. J. Natl. Cancer Inst. 88, 1204–1209.PubMedCrossRefGoogle Scholar
  45. 45.
    Block EFJ, Meyer MA (1998) Positron emission tomography in diagnosis of occult adenocarcinoma of the breast. Am. Surg. 64, 906–908.PubMedGoogle Scholar
  46. 46.
    Scoggins CR, Vitola JV, Sandler MP, et al. (1999) Occult breast carcinoma presenting as an axillary mass. Am. Surg. 65, 1–5.PubMedGoogle Scholar
  47. 47.
    McLeod MK (1988) Dilemmas in breast cancer: occult carcinoma and Paget’s disease of the breast. In: Harness JK, Oberman HA, Lichter AS, et al. (eds.) Breast Cancer: Collaborative Management. Lewis, Chelsea MI, pp. 211–232.Google Scholar
  48. 48.
    Ellerbroek N, Holmes F, Singletary E, et al. (1990) Treatment of patients with isolated axillary nodal metastases from an occult primary consistent with breast. Origin. Cancer 125, 43–47.Google Scholar
  49. 49.
    Weinberger HA, Stetten D (1951) Extensive secondary axillary lymph node carcinoma without clinical evidence of primary breast lesion. Surgery 29, 217–223.PubMedGoogle Scholar
  50. 50.
    Forquet A, de la Rochefordiere A, Campana F (in press) Occult primary cancer with axillary metastases. In: Harris JR, Lippman ME, Morrow M, et al. (eds.) Diseases of the Breast. Lippincott-Raven, Williams & Wilkins, Philadelphia, pp. 703–707.Google Scholar
  51. 51.
    Atkins H, Wolff B (1960) The malignant gland in the hospital. Guys Hosp. Rep. 1, 109–113.Google Scholar
  52. 52.
    Campana F, Forquet A, Ashby MA, et al. (1989) Presentation of axillary lymphadenopathy without detectable breast primary (TONlb breast cancer): experience at Institut Curie. Radiother. Oncol. 15, 321–325.PubMedCrossRefGoogle Scholar
  53. 53.
    Klopp CT (1950) Metastatic cancer of axillary lymph node without a demonstrable primary lesion. Ann. Surg. 131, 437.PubMedCrossRefGoogle Scholar
  54. 54.
    Van Ooijen B, Bontenbal M, Henzen-Logmans SC, et al. (1993) Axillary nodal metastases from an occult primary consistent with breast carcinoma. Br. J. Surg. 80, 1299–1300.PubMedCrossRefGoogle Scholar
  55. 55.
    Forquet A, de la Rochefordiere A, Campana F (1996) Occult primary cancer with axillary metastases. In: Harris JR, Lippman ME, Morrow M, et al. (eds.) Diseases of the Breast. Lippincott-Raven, Philadelphia, pp. 892–896.Google Scholar
  56. 56.
    Rosen PP, Kimmell M (1990) Occult breast carcinoma presenting with axillary lymph node metastases: a follow up study of 48 patients. Hum. Pathol. 21, 518–523.PubMedCrossRefGoogle Scholar
  57. 57.
    Quiet CA, Ferguson DJ, Weichselbaum RR, et al. (1996) Natural history of node-positive breast cancer: the curability of small cancers with a limited number of positive nodes. J. Clin. Oncol. 14, 3105–3111.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Shirley Scott
  • Monica Morrow

There are no affiliations available

Personalised recommendations