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01-11-2018 | Review

Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes

Authors: Mitsuo Terada, Yayoi Adachi, Masataka Sawaki, Masaya Hattori, Akiyo Yoshimura, Gondo Naomi, Haruru Kotani, Madoka Iwase, Ayumi Kataoka, Sakura Onishi, Kayoko Sugino, Makiko Mori, Nanae Horisawa, Eiichi Sasaki, Yasushi Yatabe, Hiroji Iwata

Published in: Breast Cancer Research and Treatment | Issue 1/2018

Abstract

Purpose

Occult breast cancer (OBC) is classified as a carcinoma of unknown primary, and involves axillary lymphadenopathy and is histologically consistent with metastatic breast cancer. OBC has been conventionally considered as a metastatic lymph node lesion, the origin of which is an undetectable breast tumor. Therefore, OBC patients would usually have undergone axillary lymph node dissection, and mastectomy or whole breast radiotherapy (WBRT). However, majority of OBC reports have been based on cases that were diagnosed during a period when diagnostics was still relatively primitive, and when magnetic resonance imaging was not yet a standard preoperative assessment. Therefore, there have been many false negatives in the breast based on preoperative assessment.

Methods

We herein hypothesize that the origin of OBC is ectopic breast tissue present in axillary lymph nodes (ALNs). If our hypothesis is true, mastectomy and WBRT may be unnecessary for OBC patients.

Results

Our hypothesis is supported by several findings. First, advances in radiological imaging have suggested that a primary breast tumor is absent in OBC patients. Second, proliferative breast lesions arising from ectopic breast present in ALNs have been reported. Lastly, cellular subtypes in OBC based on immunohistochemistry are of various types including ordinary breast cancer and the prognosis is not worse than stage II breast cancer.

Conclusion

It is important to distinguish between “primary” OBC in ALNs and “metastatic” OBC from micro-primary breast tumor. Further studies are required to determine if omission of mastectomy and WBRT is acceptable.

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Title: Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes
Authors: Mitsuo Terada
Yayoi Adachi
Masataka Sawaki
Masaya Hattori
Akiyo Yoshimura
Gondo Naomi
Haruru Kotani
Madoka Iwase
Ayumi Kataoka
Sakura Onishi
Kayoko Sugino
Makiko Mori
Nanae Horisawa
Eiichi Sasaki
Yasushi Yatabe
Hiroji Iwata
Publication date: 01-11-2018
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 1/2018
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-018-4898-4

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Abstract

Purpose

Methods

Results

Conclusion

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