Diagnostic value of needle aspiration cytology in the assessment of palpable axillary lymph nodes. A study of 336 cases

Rare axillary cancer of unknown primary originating from the breast of a 64‑year‑old male patient: A case report and literature review

Cancers of unknown primary (CUPs) are a heterogeneous group of tumors characterized by a difficult diagnosis. The primitive tumor remains unknown, whereas metastases are the most common manifestation. Occult male breast cancers are very rare types of CUPs. The present study describes the case of a 64-year-old man affected by a CUP of presumed mammary origin. The aim of the article and the present review was to focus on their management. To the best of our knowledge, only thirteen cases have been reported in the literature. Because no specific guidelines are available, various approaches have been applied, influencing the treatment and the prognosis of patients with CUP.

Occult breast cancer: Where are we at?

Occult breast cancer (OBC) is described as an axillary metastatic carcinoma without detection of a primary breast lesion and is uncommon. 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. We suggest standardised definitions of OBC to facilitate more homogenous data representation in the literature. This review also discusses the conflicting heterogeneous data and its influence in determining the current management guidelines. We discuss whether the current significant surgical recommendations are necessary and postulate whether they could be safely substituted with less invasive management.

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Pathological occult breast cancer is defined as no lesion detectable on MRI or pathological breast lesion post-surgery when examined at 5mm slices

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NAC in OBC may result in the de-escalation of axillary surgery.

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Current evidence indicates that ALND with ipsilateral breast RT has equivalent outcomes compared to ALND with mastectomy

Palpable lesions as a diagnostic tool in patients with thoracic pathology

Palpable lesion(s) noticed in a patient with thoracic disease may be a useful diagnostic tool and it often gives a clue for further management. In this study, we searched the diagnostic value of palpable lesions in patients with thoracic pathology suspected clinically and/or radiologically. We prospectively examined the correlations of clinical/radiologic and pathologic findings of 72 palpable lesions from 68 patients who presented with suspect for a thoracic disease from two tertiary medical centers. Thirty-two lesions (44.4%) were diagnosed as malignant either by fine-needle aspiration (FNA) only or FNA with confirmatory biopsy. The most common malignancy was non-small-cell carcinoma (10) followed by adenocarcinoma (6), and small-cell carcinoma (5). The most common localization of the palpable lesions was cervical region (20.8%) followed by left supraclavicular (13.8%) and anterior chest wall (13.8%). FNA was effective in obtaining an accurate diagnosis in 66.6% of the patients. Tissue confirmation of FNA was performed in 54 patients. The sensitivity, specificity, negative predictive value, and positive predictive value of FNA in distinguishing a malignant lesion from a benign disease for these palpable lesions were 75, 97, 96, and 80, respectively. One false negativity and one false positivity were also found. Abnormal radiologic features were not correlated with having a malignant palpable lesion. Evaluation of the palpable lesions by FNA and tissue biopsy together is effective for initial triage of the patients with suspect for a thoracic pathology. FNA alone is a convenient and easy method for this purpose especially when the material is immediately assessed for specimen adequacy.

Non-Hodgkin's lymphoma of the breast: a review of 18 primary and secondary cases

We evaluated the clinical features, morphology, and incidence of 18 cases of breast lymphoma over 10 years at the University of Alabama at Birmingham. Fine needle aspiration was performed in 7 of 18 patients, and tissue biopsy/resection was available for all 18 cases. Patients were 33 to 91 years old (median, 61); 17 were women and 1 was a man. Fine needle aspiration was consistent with the tissue diagnosis in 6 of the 7 cases (86%). One case was diagnosed by fine needle aspiration as atypical cells, favor benign; the biopsy revealed diffuse large B-cell lymphoma. Tissue diagnoses revealed that 11 cases (61%) represented diffuse large B-cell lymphoma and 3 (17%) were follicular lymphomas. The remaining 4 cases (22%) were plasma cell neoplasm, T-cell neoplasm, Burkitt's lymphoma, and precursor B-cell lymphoblastic lymphoma. Flow cytometry and/or gene rearrangement supported the diagnosis of lymphoma in 8 cases. Although rare, lymphoma should be considered in the differential diagnosis of a breast mass. Fine needle aspiration can facilitate appropriate triage of patients for further management.