Metastases from Occult Breast Cancer: A Case Report of Carcinoma of Unknown Primary Syndrome

Abstract

Carcinoma of unknown primary (CUP) syndrome occurs when metastases from an unknown primary site spread to multiple organs. Occult breast cancer (OBC) is defined as a clinically recognizable metastatic carcinoma from an undetectable primary breast tumor. It accounts for 0.3–1% of all breast cancers, often presenting with lymph node, bone, and skin metastases. Clinical and radiological examinations represent the first steps in the diagnostic algorithm for CUP syndrome from OBC. However, histological and immunohistochemical analyses, multidisciplinary team evaluation, and a multidisciplinary therapy are essential in the diagnosis and treatment of CUP syndrome from OBC. We report the case of a 52-year-old woman who underwent the removal of a parietal skin lesion. The histological and immunohistochemical analyses suggested a breast cancer origin. Clinical assessment and laboratory and radiological examinations did not locate the primary tumor. Hormone therapy was offered to the patient; however, she refused it. After 28 months, the patient reported a right cervical lump, and a total-body positron emission tomography showed dissemination of the disease to the lymph nodes and bone. A CUP syndrome from OBC was diagnosed. A multimodality approach with radiotherapy and hormone and biological therapy was started. At present, 5 years from the first presentation, the patient is asymptomatic despite the disseminated disease.

Regional Lymph Node Metastasis and Axillary Surgery of Microinvasive Breast Cancer: A Population-Based Study

“…In addition, early breast cancer has been suggested to be a systemic disease, and sometimes breast tumors metastasize with unknown primary [22,23]. For instance, 28 excluded patients in this series presented with bone, lung, or brain metastases at initial diagnosis.…”

Occult breast cancer presenting as metastatic carcinoma in a right axillary lymph node of a post-menopausal female: A case report and review of literature

“…Occult breast cancer (OBC) was first described by Halsted in 1907 as a cancerous axillary gland with nondemonstrable cancer of the mamma [1] and is defined as a clinically recognizable metastatic carcinoma from an undetectable primary breast tumor [2]. This definition of OBC has also evolved to include clinically recognizable metastatic disease with no clinical primary, radiological or pathological, breast carcinoma [2]. This is due to the advancement in the use of modern imaging modalities for breast cancer screening and diagnosis.…”

“…The yield for the diagnosis of breast cancer has increased significantly with the use of modern imaging modalities like digital mammography, digital breast tomosynthesis (DBT), ultrasonography, and magnetic resonance imaging (MRI). Occult breast cancer is rare but accounts for only 0.3-1% of all breast cancers, often presenting with lymph node, bone and skin metastases [2]. Occult breast cancer can be a diagnostic and therapeutic challenge to the surgeons and pathologists [2][3][4][5][6].…”

“…Occult breast cancer is rare but accounts for only 0.3-1% of all breast cancers, often presenting with lymph node, bone and skin metastases [2]. Occult breast cancer can be a diagnostic and therapeutic challenge to the surgeons and pathologists [2][3][4][5][6].…”

Lymphatic Endothelial Markers and Tumor Lymphangiogenesis Assessment in Human Breast Cancer

“…Metastasis via lymphatic vessels or blood vessels is the leading cause of death for breast cancer, and tumor lymphangiogenesis and angiogenesis are critical prerequisites for the tumor invasion–metastasis cascade [ 2 , 3 , 4 ]. Whether breast cancer cells gain access to the systematic circulation via blood vessels or via lymphatic vessels at the primary tumor site remains an open question [ 3 , 5 , 6 , 7 ]. It is well known that angiogenesis is a critical process for cancer growth, and anti-angiogenic therapy has been incorporated into treatment guidelines for some solid tumors [ 8 ].…”