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Spontaneous Regression Of Occult Breast Cancer With Axillary Lymph Node Metastasis: A Case Report

Takayama, S. 2019Breast cancer

Takayama, S., Satomi, K., Yoshida, M., Watase, C., Murata, T., Shiino, S., Jimbo, K., & Suto, A. (2019). Spontaneous regression of occult breast cancer with axillary lymph node metastasis: A case report. International journal of surgery case reports, 63, 75–79. https://doi.org/10.1016/j.ijscr.2019.09.017

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Abstract

INTRODUCTION: Spontaneous regression of a malignant tumor is defined as "the partial or complete disappearance of a malignant tumor in the absence of any treatment." Herein, we report a case of occult breast cancer with axillary lymph node metastasis that showed spontaneous tumor regression based on the histopathological findings. PRESENTATION OF THE CASE: A 67-year-old woman presented with left armpit pain and a lump. Previous examination by another doctor revealed swelling of the left axillary lymph node, but it was difficult to identify the primary lesion. Needle biopsy of the left axillary lymph node revealed malignant tumor tissue with extensive necrosis on histological examination. On initial examination at our hospital, the left axillary lymph node was observed to have shrunk compared to previous observations. Moreover, findings indicated a suspected concentrated cyst in the left breast, with slight contrast enhancement on magnetic resonance imaging. Considering a diagnosis of occult breast cancer with axillary lymph node metastasis, excisional biopsy was performed for the left breast mass and axillary lymph node dissection for left axillary lymph node metastasis. Histological examination revealed a micro adenocarcinoma with lymphocyte infiltration in the left breast, and the viable tumor in the left axillary lymph node had disappeared. The histopathological findings of the primary tumor and dissected lymph nodes suggested the possibility of spontaneous regression of both the primary and metastatic lesions, because effective preoperative therapy was not performed.

Case Details

Disease Location

Breast, axillary lymph node

Personal Characteristics

67-year-old woman

Clinical Characteristics

Consulted with pain and a lump in the left axilla. Needle biopsy revealed a malignant tumor on histological examination. Ultrasound revealed in the upper outer region of the left breast, a circular tumor was observed with a clear boundary and a 3.5-mm internal hypoechoic lesion. A swollen lymph node with a 15 × 15-mm hypoechoic lesion was found in the left axilla. Cancer metastasis to the left axillary lymph node was suspected. Left breast tumor excision (partial breast excision) and left axillary lymph node dissection was performed. A 3 × 2-mm adenocarcinoma was diagnosed in the upper outer region. Histological examination revealed a well-defined tumor with a high degree of inflammatory cell infiltration in the breast parenchyma

Remission Characteristics

Necrosis and a collection of histiocytes were observed in one of the left axillary lymph nodes. Immunohistochemistry revealed that the ae1/ae3-positive tumor cells did not metastasize. The area presumed to be the original tumor location showed foamy histiocytes instead of tumor cells. Viable malignant tumor cells disappeared from the left axillary lymph node

Treatment & Mechanisms

Proposed Remission Mechanisms

Immunological reactions may be involved in spontaneous regression.

Clinical Treatment

Biopsy, tumor excision, axillary lymph node dissection

Non-Clinical Treatment

None reported