Asian Journal of Case Reports in Surgery

A Case of Axillary Tail of Spence Carcinoma or Occult Breast Carcinoma?- A Diagnostic Dilemma

Lim Y. P. *

Department of Surgery, Bintulu Hospital, Sarawak, Malaysia.

Rossly F.

Department of Surgery, Bintulu Hospital, Sarawak, Malaysia.

Ng K. H.

Department of Radiology, Bintulu Hospital, Sarawak, Malaysia.

Chia P. Y.

Department of Pathology, Sarawak General Hospital, Sarawak, Malaysia.

*Author to whom correspondence should be addressed.

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Abstract

Introduction: Carcinoma of the axillary tail of Spence (CATS) is rare with an incidence of 0.1-2%. It is a type of breast cancer that develops at a specific anatomical position in the breast and often under-diagnosed.

Case Presentation: A 37 year-old lady presented with an axillary swelling for 2 months. Clinically, an axillary lump was palpable and an ultrasound confirmed a 1cm axillary node. Excision of this node revealed metastatic carcinoma with breast as the primary, ER/PR positive, HER-2 negative. Mammogram and MRI performed showed no suspicious breast lesions. CT TAP confirms no distant metastasis. Excision of the previous scar tissue revealed non-sizeable invasive carcinoma, with deep margins involved. Axillary dissection showed 5/13 positive lymph nodes, pT0N2a. Re-excision of the deep margins revealed invasive carcinoma with 3mm foci of invasion. The final pathological staging was pT1a N2a M0 and adjuvant chemoradiotherapy was commenced.

Discussion: Careful evaluation is necessary to differentiate CATS from other diagnoses such as occult carcinoma, lymphoma or non-breast metastatic lymphadenopathy. In our case, the initial diagnosis of occult carcinoma was a possibility, and the pathology of CATS was proven much later despite an MRI performed. This diagnostic dilemma is faced by surgeons, radiologists, pathologists and oncologists, especially in a setting where resources are limited. Prompt diagnosis is important as prognosis is proven to be worse than cancers in other locations of the breast.

Conclusion: When dealing with patients with an axillary swelling, it is crucial to keep the diagnosis of CATS in mind.

Keywords: Breast cancer, axillary tail, axillary swelling, axillary tail of Spence

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