IMR Press / EJGO / Volume 36 / Issue 2 / DOI: 10.12892/ejgo2574.2015

European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on as a courtesy and upon agreement with S.O.G.

Original Research
Isolated axillary nodal swelling and cancer of unknown primary
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1 Department of Surgery, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia", Udine
2 Clinic of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia", Udine (Italy)
Eur. J. Gynaecol. Oncol. 2015, 36(2), 123–130;
Published: 10 April 2015

Introduction: The literature reports rare cases of isolated axillary lymph node metastasis from cancer of unknown primary (CUP). The authors reviewed the prevalence and outcome of patients with isolated axillary nodal swelling suspicious for malignancy affected or not by isolated axillary node metastasis from CUP. Materials and Methods: The authors collected data about 65 patients presented with isolated axillary lymph node swelling who underwent axillary lymph node excisional biopsy for malignancy suspicion, between January 2005 and December 2011, in the absence of any specific diagnosis. Results: Histological examination revealed a metastatic infiltration by an occult solid cancer in 16 cases (24%), ten of which were occult breast cancers. Histological patterns and molecular markers allowed in all cases of occult cancer a probable identification of the primary tumor site, while a definitive diagnosis was possible only in the 56.25% of cases (9/16). The prognosis of these patients was very poor with a five-year overall survival of 28%, and thus very similar to patients affected by Stage IV overt breast cancer. Conclusions: Among occult malignancies presenting with sole axillary lymph node metastasis, breast cancer remains the more probable primary cancer, but many other sites should be taken into consideration by negative breast imaging. Positron-emission tomography computed tomography (PET-CT) resulted helpful in the primary site detection, but has nonetheless a margin of failure. Occult breast cancers behave very similar to Stage IV overt breast cancers, and should be treated accordingly.
CUP syndrome
Cancer of unknown primary
Axillary lymph node metastasis
Occult tumor
Breast cancer
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