Lanitis S, Behranwala K A, Al-Mufti R, Hadjiminas D
St Mary's hospital, Praed street, Paddington, London W2 1NY, UK.
Breast. 2009 Aug;18(4):225-7. doi: 10.1016/j.breast.2009.07.002. Epub 2009 Aug 4.
Atypical axillary metastasis may arise from an occult ipsilateral or contralateral breast cancer or from primary non-breast tumour. The treatment of this entity is challenging and presents various options. We present our experience with a brief review of the literature.
A study of atypical axillary metastasis done at St Mary's hospital, from 1998 to 2008, identified six cases. Radiological investigations and immunohistochemistry excluded non-breast primary tumour. Three patients had occult breast cancer on presentation, two patients had previously treated contralateral breast cancer and one patient developed a primary metachronous contralateral breast cancer, which had a completely different histological profile from the involved lymph nodes on the same side. Axillary nodal clearance was done for all patients except for the patient with lymphoedema. Four patients were alive with no evidence of disease and two patients died of the disease at a median follow-up of 23 months.
Atypical axillary metastasis from ipsilateral occult or contralateral breast cancer should be treated with axillary node clearance and further endocrine or chemotherapy. Radiation treatment or a watchful policy to the ipsilateral breast should be validated by further studies.
非典型腋窝转移可能源于隐匿性同侧或对侧乳腺癌，或源于原发性非乳腺癌肿瘤。对该实体的治疗具有挑战性，且存在多种选择。我们介绍我们的经验并简要回顾文献。
1998年至2008年在圣玛丽医院对非典型腋窝转移进行的一项研究确定了6例病例。影像学检查和免疫组化排除了非乳腺原发性肿瘤。3例患者初诊时患有隐匿性乳腺癌，2例患者曾接受对侧乳腺癌治疗，1例患者发生了原发性异时性对侧乳腺癌，其组织学特征与同侧受累淋巴结完全不同。除有淋巴水肿的患者外，所有患者均进行了腋窝淋巴结清扫。4例患者存活且无疾病证据，2例患者在中位随访23个月时死于该疾病。
同侧隐匿性或对侧乳腺癌引起的非典型腋窝转移应采用腋窝淋巴结清扫及进一步的内分泌或化疗进行治疗。同侧乳房的放射治疗或观察策略应通过进一步研究加以验证。
