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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.