Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes
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 b...
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creator | Terada, Mitsuo Adachi, Yayoi Sawaki, Masataka Hattori, Masaya Yoshimura, Akiyo Naomi, Gondo Kotani, Haruru Iwase, Madoka Kataoka, Ayumi Onishi, Sakura Sugino, Kayoko Mori, Makiko Horisawa, Nanae Sasaki, Eiichi Yatabe, Yasushi Iwata, Hiroji |
description | 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. |
doi_str_mv | 10.1007/s10549-018-4898-4 |
format | Article |
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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.</description><identifier>ISSN: 0167-6806</identifier><identifier>EISSN: 1573-7217</identifier><identifier>DOI: 10.1007/s10549-018-4898-4</identifier><identifier>PMID: 30030707</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Axilla - pathology ; Biopsy ; Breast - pathology ; Breast cancer ; Breast Neoplasms - etiology ; Breast Neoplasms - pathology ; Cancer metastasis ; Cancer research ; Choristoma - pathology ; Female ; Humans ; Hypotheses ; Immunohistochemistry ; Lymph nodes ; Lymph Nodes - pathology ; Lymphadenopathy ; Lymphatic Metastasis ; Lymphatic system ; Magnetic resonance imaging ; Mastectomy ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Neoplasms, Unknown Primary - etiology ; Neoplasms, Unknown Primary - pathology ; NMR ; Nuclear magnetic resonance ; Oncology ; Radiation therapy ; Review</subject><ispartof>Breast cancer research and treatment, 2018-11, Vol.172 (1), p.1-7</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2018</rights><rights>COPYRIGHT 2018 Springer</rights><rights>Breast Cancer Research and Treatment is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-c5243b7bf1c218768beba97acb22daff5433114e949efce0cb011db8eecd5eec3</citedby><cites>FETCH-LOGICAL-c470t-c5243b7bf1c218768beba97acb22daff5433114e949efce0cb011db8eecd5eec3</cites><orcidid>0000-0002-1304-2619</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10549-018-4898-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10549-018-4898-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30030707$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Terada, Mitsuo</creatorcontrib><creatorcontrib>Adachi, Yayoi</creatorcontrib><creatorcontrib>Sawaki, Masataka</creatorcontrib><creatorcontrib>Hattori, Masaya</creatorcontrib><creatorcontrib>Yoshimura, Akiyo</creatorcontrib><creatorcontrib>Naomi, Gondo</creatorcontrib><creatorcontrib>Kotani, Haruru</creatorcontrib><creatorcontrib>Iwase, Madoka</creatorcontrib><creatorcontrib>Kataoka, Ayumi</creatorcontrib><creatorcontrib>Onishi, Sakura</creatorcontrib><creatorcontrib>Sugino, Kayoko</creatorcontrib><creatorcontrib>Mori, Makiko</creatorcontrib><creatorcontrib>Horisawa, Nanae</creatorcontrib><creatorcontrib>Sasaki, Eiichi</creatorcontrib><creatorcontrib>Yatabe, Yasushi</creatorcontrib><creatorcontrib>Iwata, Hiroji</creatorcontrib><title>Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes</title><title>Breast cancer research and treatment</title><addtitle>Breast Cancer Res Treat</addtitle><addtitle>Breast Cancer Res Treat</addtitle><description>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.</description><subject>Axilla - pathology</subject><subject>Biopsy</subject><subject>Breast - pathology</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - etiology</subject><subject>Breast Neoplasms - pathology</subject><subject>Cancer metastasis</subject><subject>Cancer research</subject><subject>Choristoma - pathology</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Immunohistochemistry</subject><subject>Lymph nodes</subject><subject>Lymph Nodes - pathology</subject><subject>Lymphadenopathy</subject><subject>Lymphatic Metastasis</subject><subject>Lymphatic system</subject><subject>Magnetic resonance imaging</subject><subject>Mastectomy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Neoplasms, Unknown Primary - etiology</subject><subject>Neoplasms, Unknown Primary - pathology</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Oncology</subject><subject>Radiation therapy</subject><subject>Review</subject><issn>0167-6806</issn><issn>1573-7217</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kV9rFTEQxYMo9lr9AL5IQJC-bJ382c3uYylahUJf9FFCNjt7b8puck2y0PvtzXJba0UJTGDyO4eZHELeMjhnAOpjYlDLrgLWVrLtSnlGNqxWolKcqedkA6xRVdNCc0JepXQLAJ2C7iU5EQACFKgN-XFj7TJl2kc0KVNrvMVIZ3OgIbqt8yYjHWOYKdoc9s4-gNmltCDdR0zoM3Wemjs3TSYe6HSY9zvqw4DpNXkxminhm_v7lHz__Onb5Zfq-ubq6-XFdWWlglzZmkvRq35klrNWNW2PvemUsT3ngxnHWgrBmMROdjhaBNsDY0PfItqhLkWckrOj7z6GnwumrGeXLJZ5PIYlaQ5KCC4BmoK-_wu9DUv0ZbqV4nUjJPBHamsm1M6PIUdjV1N9UdetZKxuV-r8H1Q5A87OBo-jK_0ngg9_CHZoprxLYVqyCz49BdkRtDGkFHHU--jm8ruagV6z18fsdcler9lrWTTv7jdb-hmH34qHsAvAj0AqT36L8XH1_7v-AmtkuGE</recordid><startdate>20181101</startdate><enddate>20181101</enddate><creator>Terada, Mitsuo</creator><creator>Adachi, Yayoi</creator><creator>Sawaki, Masataka</creator><creator>Hattori, Masaya</creator><creator>Yoshimura, Akiyo</creator><creator>Naomi, Gondo</creator><creator>Kotani, Haruru</creator><creator>Iwase, Madoka</creator><creator>Kataoka, Ayumi</creator><creator>Onishi, Sakura</creator><creator>Sugino, Kayoko</creator><creator>Mori, Makiko</creator><creator>Horisawa, Nanae</creator><creator>Sasaki, Eiichi</creator><creator>Yatabe, Yasushi</creator><creator>Iwata, Hiroji</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1304-2619</orcidid></search><sort><creationdate>20181101</creationdate><title>Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes</title><author>Terada, Mitsuo ; Adachi, Yayoi ; Sawaki, Masataka ; Hattori, Masaya ; Yoshimura, Akiyo ; Naomi, Gondo ; Kotani, Haruru ; Iwase, Madoka ; Kataoka, Ayumi ; Onishi, Sakura ; Sugino, Kayoko ; Mori, Makiko ; Horisawa, Nanae ; Sasaki, Eiichi ; Yatabe, Yasushi ; Iwata, Hiroji</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-c5243b7bf1c218768beba97acb22daff5433114e949efce0cb011db8eecd5eec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Axilla - pathology</topic><topic>Biopsy</topic><topic>Breast - pathology</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - etiology</topic><topic>Breast Neoplasms - pathology</topic><topic>Cancer metastasis</topic><topic>Cancer research</topic><topic>Choristoma - pathology</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Immunohistochemistry</topic><topic>Lymph nodes</topic><topic>Lymph Nodes - pathology</topic><topic>Lymphadenopathy</topic><topic>Lymphatic Metastasis</topic><topic>Lymphatic system</topic><topic>Magnetic resonance imaging</topic><topic>Mastectomy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Neoplasms, Unknown Primary - etiology</topic><topic>Neoplasms, Unknown Primary - pathology</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Oncology</topic><topic>Radiation therapy</topic><topic>Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Terada, Mitsuo</creatorcontrib><creatorcontrib>Adachi, Yayoi</creatorcontrib><creatorcontrib>Sawaki, Masataka</creatorcontrib><creatorcontrib>Hattori, Masaya</creatorcontrib><creatorcontrib>Yoshimura, Akiyo</creatorcontrib><creatorcontrib>Naomi, Gondo</creatorcontrib><creatorcontrib>Kotani, Haruru</creatorcontrib><creatorcontrib>Iwase, Madoka</creatorcontrib><creatorcontrib>Kataoka, Ayumi</creatorcontrib><creatorcontrib>Onishi, Sakura</creatorcontrib><creatorcontrib>Sugino, Kayoko</creatorcontrib><creatorcontrib>Mori, Makiko</creatorcontrib><creatorcontrib>Horisawa, Nanae</creatorcontrib><creatorcontrib>Sasaki, Eiichi</creatorcontrib><creatorcontrib>Yatabe, Yasushi</creatorcontrib><creatorcontrib>Iwata, Hiroji</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Breast cancer research and treatment</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Terada, Mitsuo</au><au>Adachi, Yayoi</au><au>Sawaki, Masataka</au><au>Hattori, Masaya</au><au>Yoshimura, Akiyo</au><au>Naomi, Gondo</au><au>Kotani, Haruru</au><au>Iwase, Madoka</au><au>Kataoka, Ayumi</au><au>Onishi, Sakura</au><au>Sugino, Kayoko</au><au>Mori, Makiko</au><au>Horisawa, Nanae</au><au>Sasaki, Eiichi</au><au>Yatabe, Yasushi</au><au>Iwata, Hiroji</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes</atitle><jtitle>Breast cancer research and treatment</jtitle><stitle>Breast Cancer Res Treat</stitle><addtitle>Breast Cancer Res Treat</addtitle><date>2018-11-01</date><risdate>2018</risdate><volume>172</volume><issue>1</issue><spage>1</spage><epage>7</epage><pages>1-7</pages><issn>0167-6806</issn><eissn>1573-7217</eissn><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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30030707</pmid><doi>10.1007/s10549-018-4898-4</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1304-2619</orcidid></addata></record> |
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subjects | Axilla - pathology Biopsy Breast - pathology Breast cancer Breast Neoplasms - etiology Breast Neoplasms - pathology Cancer metastasis Cancer research Choristoma - pathology Female Humans Hypotheses Immunohistochemistry Lymph nodes Lymph Nodes - pathology Lymphadenopathy Lymphatic Metastasis Lymphatic system Magnetic resonance imaging Mastectomy Medicine Medicine & Public Health Metastases Metastasis Neoplasms, Unknown Primary - etiology Neoplasms, Unknown Primary - pathology NMR Nuclear magnetic resonance Oncology Radiation therapy Review |
title | Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes |
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