914
Chapter 33
76%.
132,138,170,177,178
A primary tumor was detected clinically
during follow-up in the ipsilateral breast of 7% to 33% of
these patients.
Prognosis
The first large series of patients with occult breast carci
noma presenting as axillary nodal metastases with follow-up
from a single institution, the Mayo Clinic, was published in
1954.
174
This article included the first reported example of
this condition in a man. Follow-up of 25 patients revealed
that 9 patients (36%) died of breast carcinoma, 3 (12%) died
of other causes, and 13 (52%) remained well. The authors
concluded that these patients had “a better prognosis than is
observed for the average carcinoma of the breast with nodal
metastasis.”
Ta b l e 3 3 . 2
Primary Carcinomas Found
in Breast
No. (%)
*
Invasive
22 (79)
Invasive duct
(65)
Invasive lobular
(6)
Medullary
(6)
Colloid
(3)
Noninvasive
7 (21)
Intraductal
(12)
In situ
lobular
(6)
Intraductal and
in situ
lobular
(3)
Adapted from Rosen PP, Kimmel M. Occult breast carcinoma pre-
senting with axillary lymph node metastases: a follow-up study of
48 patients.
Hum Pathol
1990;21:518–523.
*
Percentages rounded.
Ta b l e 3 3 . 3
Follow-up of Patients with Occult Breast Carcinoma
Total Patients
Number of Involved Lymph Nodes
a
One to Three
Four or More
Unknown
Status
# (%)
*
# (%)
# (%)
# (%)
NED
29 (60)
12 (60)
14 (70)
3 (38)
AWD
3 (6)
1 (5)
1 (5)
1 (12)
DOD
12 (25)
5 (25)
4 (20)
3 (38)
DOC
2 (4)
1 (5)
1 (5)
0 0)
UNK
2 (4)
1 (5)
0 (0)
1 (12)
Total
48
20
20
8
NED, alive, no evidence of disease; AWD, alive with disease; DOC, dead of other causes; UNK, unknown; DOD, dead of disease.
a
Includes lymph node(s) removed for diagnosis and those obtained by axillary dissection.
*
Percentages rounded.
Based on Rosen PP, Kimmel M. Occult breast carcinoma presenting with axillary lymph node metastases: a follow-up study of 48 patients.
Hum Pathol
1990;21:518–523.
Several later studies also described a relatively favorable
clinical course for patients treated by mastectomy and axil
lary dissection. Patel et al.
134
reported that 29% of patients
died of disease, suggesting that the “prognosis is as good as
or better than it is for palpable breast cancer with axillary
metastases.” Two follow-up studies from Memorial Hospi
tal in New York reported that 23%
129
and 25%
135
of patients
died of breast carcinoma. In reports based on smaller series,
9%
131
and 12%
133
of patients had recurrent carcinoma and/
or died of breast carcinoma.
Survival results for a series of 48 patients are shown in Ta
ble 33.3.
135
Follow-up ranged from 5 to 267 months (mean,
71; median, 60). Among patients alive and disease free, fol
low-up ranged from 33 to 367 months (median, 64 months;
mean, 73 months). The intervals between diagnosis of breast
carcinoma and the deaths of two patients of causes other
than mammary carcinoma were 91 and 204 months. Two
other patients surviving with recurrent carcinoma were alive
53 to 166 months after the original diagnosis of carcinoma in
an ALN. Patients who died of metastatic carcinoma survived
5 to 68 months (median, 26 months; mean, 31 months).
Overall, 29 of the 48 patients (60%) remained alive and
disease free. Two women (4%) died of causes other than
mammary carcinoma, and the status of 2 patients (4%) was
unknown. Recurrences occurred in 15 cases (31%), including
12 patients (25%) who died of metastatic breast carcinoma.
There was not a statistically significant difference in the fre
quency of recurrence or of death due to breast carcinoma
between patients with one to three positive lymph nodes and
those with four or more affected nodes, although the recur
rence rate was higher in the latter group.
Twenty-two of the patients in the preceding study found
to have a measurable primary tumor at mastectomy were
chosen for a case-control analysis of survival.
135
Match
ing was based on tumor size (
0.5 cm in T category), total
number of involved lymph nodes (one to three vs. four or
more, selected for closest total count), tumor type, and age
at diagnosis. All patients were treated by mastectomy, and
