Occult breast cancer presenting with axillary metastasis

The literature of occult breast cancer is reviewed and the management of our 43 patients is discussed. In 20 patients mastectomy and axillary block dissection, in nine upper-outer quadrant resection of the breast with axillary block dissection, and in two axillary biopsy were carried out. The primary tumour was found only in 11 patients during the first operation, either by macroscopic or microscopic examination. In 12 patients the primary breast tumour became detectable only later. Out of the 20 mastectomy specimens two primary tumours could not be identified even with the most thorough examination. In four patients of the breast conservation group the primary tumour remained occult until recently, and in the axillary block dissection group (12 patients) the site of the primary cancer could be identified only in two patients. The difficulties of the diagnosis and the dilemmas of the surgical indications and treatment are dealt with.