Metachronous secondary primary occult breast cancer initially presenting with metastases to the contralateral axillary lymph nodes: report of a case |
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Authors: | Satoki Kinoshita Akio Hirano Susumu Kobayashi Kazumasa Komine Shigeya Kyoda Hiroshi Takeyama Ken Uchida Toshiaki Morikawa Jison Nagase Goi Sakamoto |
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Institution: | (1) Department of Surgery, Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa Chiba, 277-8567, Japan;(2) Department of Clinical Pathology, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan;(3) Department of Breast and Endocrine Surgery, Jikei University School of Medicine, Tokyo, Japan;(4) Nagase Breast Clinic, Kashiwa, Chiba, Japan;(5) Sakamoto Memorial Clinic Academy of Breast Pathology, Tokyo, Japan |
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Abstract: | We report a rare case of a 64-year-old female with metachronous secondary primary left occult breast cancer initially presenting
right axillary lymph node metastases. The patient, who had received breast-conserving therapy for left breast cancer at another
hospital about 4.5 years ago, came to our hospital complaining of right axillary node swelling. After both breast and systemic
examination, she received complete right axillary lymph node dissection. Just after the operation, she was diagnosed with
right occult breast cancer by a review of the right axillary lymph nodes and previous left breast cancer. She was followed
by radiation and systemic chemoendocrine therapies. One year after axillary lymph node dissection, mammography and ultrasonography
showed a new lesion in her left breast. Core needle biopsy revealed similar findings to right axillary lymph node metastasis.
After salvage surgery, the diagnosis was revised. We recommend that patients without clinical findings except for axillary
lymph node metastasis, especially post-breast-conserving surgery followed by radiation therapy, should be considered not
only as having ipsilateral but also contralateral occult breast cancer. If there is no evidence of a primary lesion, axillary
lymph node dissection needs to be carried out, and the patient should be offered the choice of radiation therapy or mastectomy
followed by proper systemic therapy. |
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