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Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes

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A Letter to the Editor to this article was published on 27 August 2018

Abstract

Purpose

Occult breast cancer (OBC) is classified as a carcinoma of unknown primary, and involves axillary lymphadenopathy and is histologically consistent with metastatic breast cancer. OBC has been conventionally considered as a metastatic lymph node lesion, the origin of which is an undetectable breast tumor. Therefore, OBC patients would usually have undergone axillary lymph node dissection, and mastectomy or whole breast radiotherapy (WBRT). However, majority of OBC reports have been based on cases that were diagnosed during a period when diagnostics was still relatively primitive, and when magnetic resonance imaging was not yet a standard preoperative assessment. Therefore, there have been many false negatives in the breast based on preoperative assessment.

Methods

We herein hypothesize that the origin of OBC is ectopic breast tissue present in axillary lymph nodes (ALNs). If our hypothesis is true, mastectomy and WBRT may be unnecessary for OBC patients.

Results

Our hypothesis is supported by several findings. First, advances in radiological imaging have suggested that a primary breast tumor is absent in OBC patients. Second, proliferative breast lesions arising from ectopic breast present in ALNs have been reported. Lastly, cellular subtypes in OBC based on immunohistochemistry are of various types including ordinary breast cancer and the prognosis is not worse than stage II breast cancer.

Conclusion

It is important to distinguish between “primary” OBC in ALNs and “metastatic” OBC from micro-primary breast tumor. Further studies are required to determine if omission of mastectomy and WBRT is acceptable.

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Acknowledgements

The authors would like to thank the doctors, nurses, and technical staff of Aichi Cancer Center Hospital for their daily support.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan

    Mitsuo Terada, Yayoi Adachi, Masataka Sawaki, Masaya Hattori, Akiyo Yoshimura, Gondo Naomi, Haruru Kotani, Madoka Iwase, Ayumi Kataoka, Sakura Onishi, Kayoko Sugino, Makiko Mori, Nanae Horisawa & Hiroji Iwata

  2. Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan

    Eiichi Sasaki & Yasushi Yatabe

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  1. Mitsuo Terada
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Correspondence to Mitsuo Terada.

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The authors declare that they have no conflict of interest.

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All procedures performed involving human participants were in accordance with the ethical standards of the Institutional Review Board of Aichi Cancer Center Hospital and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Terada, M., Adachi, Y., Sawaki, M. et al. Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes. Breast Cancer Res Treat 172, 1–7 (2018). https://doi.org/10.1007/s10549-018-4898-4

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