Occult primary breast cancer: Two cases report and literature review

Abstract

Introduction and importance: Occult breast cancer (OBC) is defined as a clinically recognizable metastatic carcinoma arising from an undetectable primary breast tumor.

Presentation of case: We report in this work 2 cases of occult breast cancer treated at the Mohammed VI center of onco-gynecology of the CHU of Casablanca.

Clinical discussion: Significant advances in breast imaging have occurred since its description, decreasing its incidence. However current management is based upon old studies, with variable clinical, radiological and pathological definitions of OBC.

Conclusion: The introduction of better diagnostic techniques and more detailed pathology continue to impact the true incidence of OBC.

Summary: Carcinoma of unknown primary is an intriguing clinical phenomenon that is defined as biopsy-proven metastasis of a malignant tumor in the absence of an identifiable primary site after a complete clinical workup. Carcinoma of unknown primary accounts for approximately 3 to 5% of all cancer diagnoses, and consists of a heterogeneous group of tumors that have acquired the ability to metastasize before the development of a clinically evident primary lesion. Clinical and radiological examinations represent the first steps in the diagnostic algorithm for Carcinoma of unknown primary syndrome. However, histological and immunohistochemical analyses, together with evaluation by a multidisciplinary team and adequate therapy are essential for the diagnosis and treatment of Carcinoma of unknown primary syndrome of OBC. We report in this work 2 cases of occult breast cancer treated at the Mohammed VI center of onco-gynecology of the CHU of Casablanca; A multidisciplinary approach including surgery, radiotherapy, hormonal and biological therapy was implemented. Currently, 10 month after the first presentation, the two patient received ipsilateral breast radiotherapy and sequential adjuvant chemotherapy followed by hormone therapy. Evolution was marked by good control.

Keywords: Axillary metastasis; Carcinoma of unknown primary; Occult primary breast cancer.

Fig. 1

Ultrasound (b) mammography (a) showing axillary lymphadenopathy without glandular abnormality

Fig. 2

Breast MRI showing no radiological abnormalities

Fig. 3

Ultrasound (b) mammography (a) showing axillary lymphadenopathy without glandular abnormality

Fig. 4

Breast MRI showing no radiological abnormalities

Fig. 5

18F-FDG PETSCAN showing diffuse breast hypermetabolism