Resumen de Cancer de mama oculto: dos casos clínicos analizados según el concepto actual
Kuen Lee, Ricardo Schwartz J, Rodrigo Iglesis G, Rodrigo Vélez F, Lyonel Gómez S
Occult breast cancer is expressed as a metastatic axillary lymph node without clinical or imaging evidence of a primary tumor in the breast. The old concept involved non palpable tumors. Its incidence is low, representing only 0.3 to 1% of all breast cancer cases. The search for the primary tumors is performed with mammography, whose sensitivity is low, ranging from 0 to 56%. Several studies have shown a higher sensitivity of magnetic resonance imaging, ranging from 85 to 100%, to detect occult lesions. The treatment of isolated axillary metastases of breast cancer is controversial. An axillary dissection is recommended. If there is a suspicious image, a radiosurgical or stereotaxic biopsy should be done. However, in patients without radiological lesions in the breast, the tendency is not to perform a radical mastectomy as previously recommended, since the primary tumor will not be found in the surgical specimen in two thirds of cases. A superior and external quadrantectomy or exclusive radiotherapy should suffice. An expecting behavior is not recommended as a therapeutic alternative. Treatment should be complemented with hormonal therapy or chemotherapy. The literature suggests that prognosis is better than stage II, with a ten years survival ranging from 50 to 71%. We report two patients with a well defined occult breast cancer and based on them, a review of the subject is attempted. Considering its prognosis, physicians should be aware of this uncommon and difficult to diagnose disease
