Breast cancer presenting as a mass in the Axilla: A report of two cases

BACKGROUND: Breast cancer presenting initially as enlarged axillary lymph node is very unusual. OBJECTIVE: To highlight the less frequent clinical presentation of breast cancer as persistent isolated, unilateral axillary lymphadenopathy. METHODS: A report of two patients who presented with persistent axillary lymphadenopathy. Case one was a 65-year old woman who presented with an eight-month history of a painless mass in the right axilla. Clinical breast examination was normal. A mammogram was performed. The sub-clinical mass was excised using wire-guided localization providing a specimen for histology. A complete dissection of the right axilla was done and the specimen sent for histological examination. In a second case a 73-year old otherwise healthy woman reported for the assessment of two painful masses in the right axilla. Two hard ovoid masses 2.5 cm x 3.5 cm and 3.0 cm x 3.5 cm were palpated in the right axilla. No other masses were palpable. Both breasts were normal on examination. Mammograms and chest X-rays were done. Fine needle aspiration cytology was done on both masses. A right sided complete axillary lymph node dissection was performed. RESULTS: In case one, mammogram revealed a 5-mm sub mass in the right breast that was shown to be carcinoma. In case two the mammograms and chest X-rays were normal. Histologic examination of the surgical specimen from the axilla showed that four of the seven lymph nodes removed contained metastases. CONCLUSION: Axillary nodal metastasis as the initial presentation of breast cancer in our women is no different from the presentation in women from other populations.