title: Contralateral axillary lymph node metastasis as the first evidence of locally recurrent breast carcinoma.
abstract: BACKGROUND
  Carcinoma of the breast infrequently presents initially as axillary adenopathy. In such cases, after biopsy proves the presence of metastatic carcinoma, the primary tumor generally is assumed to be in the ipsilateral breast, despite negative mammographic findings and the lack of a clinically palpable breast mass.
  
  
  METHODS
  The authors recently studied a case of a 50-year-old woman in whom recurrent neuroendocrine carcinoma of the breast presented as a contralateral axillary lymph node metastasis. After mastectomy ipsilateral to the metastasis proved negative for tumor, a histologic comparison of the previous contralateral tumor with that in the lymph node was performed, followed by biopsy of the clinically and mammographically negative original lumpectomy site.
  
  
  RESULTS
  Histologic and immunohistochemical studies proved that the original, metastatic, and locally recurrent tumors were identical, sharing unusual neuroendocrine features. The patient is currently disease free after chemotherapy.
  
  
  CONCLUSIONS
  Contralateral mammary carcinoma should be considered in the workup of a patient who presents with evidence of an axillary lymph node metastasis. Locally recurrent breast carcinoma may be clinically and mammographically occult. Histologic review of prior biopsy material and comparison with current tissue is essential in proper patient management.
authors.affiliation: Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai Medical Center, New York, NY 10029, USA.
authors.forename: S
authors.initials: S
authors.lastname: Jaffer
authors.forename: A B
authors.initials: AB
authors.lastname: Goldfarb
authors.forename: J E
authors.initials: JE
authors.lastname: Gold
authors.forename: A
authors.initials: A
authors.lastname: Szporn
authors.forename: I J
authors.initials: IJ
authors.lastname: Bleiweiss
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018278:Carcinoma, Neuroendocrine / Q000473:pathology* / Q000601:surgery; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local