Right metastatic occult breast cancer two years after surgery of left breast cancer: a case report and review of the literature

Background: It is important to find the primary site when axillary nodes metastasis is confirmed after surgery of contralateral breast cancer. Case Report: The authors report a rare case of a 38-year-old female with right occult metastatic breast cancer initially presenting right axillary nodal metastases two years after surgery of left breast cancer. Multifocal cancers were found in all the random pathological sections after right mastectomy, but no abnormalities of the right breast were found even after full examination before surgery. Pathological examination revealed similar findings among the right axillary lymph nodes and the right breast cancer and previous left breast cancer. Six months after right mastectomy, multifocal recurrence was detected in the right parasternal. It was conformed that the right breast cancer was a metastasis from the left. Conclusion: Contralateral breast metastasis should be considered even if no lesion is confirmed when contralateral axillary node metastasis was detected post-breast cancer surgery. Combined axillary lymph node dissection (ALND) and radiation therapy would be an optimal approach, followed by proper systemic therapy.

Breast cancer; Unknown primary neoplasm metastasis; Metachronous neoplasms; Occult cancer; Metastatic cancer.

[1] Blanchard D.K., Farley D.R.: “Retrospective study of women presenting with axillary metastases from occult breast carcinoma”. World J. Surg., 2004, 28, 535.

[2] de Bresser J., de Vos B., van der Ent F., Hulsewé K.: “Breast MRI in clinically and mammographically occult breast cancer presenting with an axillary metastasis: a systematic review”. Eur. J. Surg. Oncol., 2010, 36, 114.

[3] Huston T.L., Pressman P.I., Moore A., Vahdat L., Hoda S.A., Kato M., et al.: “The presentation of contralateral axillary lymph node metastases from breast carcinoma: a clinical management dilemma”. Breast J., 2007, 13, 158.

[4] Morcos B., Jaradat I., El-Ghanem M.: “Characteristics of and therapeutic options for contralateral axillary lymph node metastasis in breast cancer”. Eur. J. Surg. Oncol., 2011, 37, 418.

[5] Vicini F.A., Antonucci J.V., Goldstein N., Wallace M., Kestin L., Krauss D., et al.: “The use of molecular assays to establish definitively the clonality of ipsilateral breast tumor recurrences and patterns of in-breast failure in patients with early-stage breast cancer treated with breast-conserving therapy”. Cancer, 2007, 109, 1264.

[6] Halsted W.S.: “The results of radical operations for the cure of carcinoma of the breast”. Ann. Surg., 1907, 46, 1.

[7] Aracava M.M., Chojniak R., Souza J.A., Bitencourt A.G., Marques E.F.: “Identification of occult breast lesions detected by magnetic resonance imaging with targeted ultrasound: a prospective study”. Eur. J. Radiol., 2014, 83, 516.

[8] Liu M., Liu B., Song Y., Ding L., Dong L.: “FDG PET/CT reveals the primary tumor in a patient with occult breast carcinoma undetected by other modalities”. Clin. Nucl. Med., 2014, 39, 755.

[9] Medeiros L.R., Duarte C.S., Rosa D.D., Edelweiss M.I., Edelweiss M., Silva F.R., et al.: “Accuracy of magnetic resonance in suspicious breast lesions: a systematic quantitative review and meta-analysis”. Breast Cancer Res. Treat., 2011, 126, 273.

[10] He M., Tang L.C., Yu K.D., Cao A.Y., Shen Z.Z., Shao Z.M., Di G.H.: “Treatment outcomes and unfavorable prognostic factors in patients with occult breast cancer”. Eur. J. Surg. Oncol., 2012, 38, 1022.

[11] Galimberti V., Bassani G., Monti S., Simsek S., Villa G., Renne G., Luini A.: “Clinical experience with axillary presentation breast cancer”. Breast Cancer Res. Treat., 2004, 88, 43.

[12] National Comprehensive Cancer Network (NCCN): “NCCN clinical practice guidelines in oncology, Breast cancer”. Available at: https://www.nccn.org/professionals/physician_gls/f_guidelines.asp# breast

[13] Macedo F.I., Eid J.J., Flynn J., Jacobs M.J., Mittal V.K.: “Optimal surgical management for occult breast carcinoma: a meta-analysis”. Ann. Surg. Oncol., 2016, 23, 1838.

[14] Chen Y., Thompson W., Semenciw R., Mao Y.: “Epidemiology of contralateral breast cancer”. Cancer Epidemiol. Biomarkers Prev., 1999, 8, 855.