Axillary metastasis from occult breast carcinoma: diagnosis and management

Axillary metastasis from carcinoma of an unknown primary site is an uncommon and difficult problem. When biopsy of an enlarged axillary node reveals adenocarcinoma, the most likely site (in a female patient) is the ipsilateral breast. From January 1977 to December 1986, 10 patients (eight female, two male) were treated at the University of Mississippi Medical Center for axillary metastasis from carcinoma of unknown primary. Two male patients (ages 60 and 63) were believed to have lung primaries. Both had evidence of distant metastasis at initial diagnosis and died 2 and 7 months after presentation. Of the eight women (ages 40-72, mean 56.5 years), seven developed breast abnormalities between 6 and 39 months (mean: 15 months) after initial diagnosis, and two of these underwent modified radical mastectomy. No primary site was identified in the eight women. Two women had evidence of distant metastases at initial presentation. All patients have died with disease at a mean of 42 months (range: 2-93 months). In contrast with other reported series, the outcome of patients with occult breast carcinoma presenting as axillary adenopathy was not favorable.