Okült Primer Meme Kanseri
Özet
Okült primer meme kanseri, memede tespit edilebilir bir lezyon olmadan aksillaya, nadiren de uzak organlara meme kanserinin metastazı sonucu saptanan klinik bir durumdur. Oldukça nadir görülür ve tüm meme kanseri vakalarının %1’den azını oluşturur. Tanıda fizik muayene, görüntüleme yöntemleri ve immünohistokimyasal belirteçler yer alır. Bu belirteçlerin hiçbiri meme kanseri tanısında sensitif ve spesifik değildir. Karsinoembriyonik antijen (CEA), sitokeratin 7 (CK7), östrojen ve progesteron reseptörü (ER ve PR), mammaglobin, kanser antijeni-125(CA-125), gross cystic disease fluid protein-15(GCDFP, BRST2 ile pozitif boyanma) pozitifliği, CK20 ve tiroid transkripsiyon faktörü (TTF-1) negatifliği, meme kanserini destekleyen bulgulardır. Evreleme toraks ve abdomen tomografisi ile yapılır, endikasyon durumunda PET/CT ve radyonüklid tetkikler görüntülemeye eklenir. Sistemik tedavi, evre 2 meme kanserine benzer şekilde yapılsa da, lokale yönelik tedaviler oldukça tartışmalıdır. Kılavuzlar ve yapılan geniş kapsamlı çalışmalar doğrultusunda standart yaklaşım, aksiller lenf nodu diseksiyonu (ALND) ve mastektomi veya aksiller lenf nodu diseksiyonu ve primere yönelik radyoterapi uygulanması gibi görülse de, son dönemlerde yapılan güncel çalışmalarla birlikte neoadjuvan tedaviler sonrası meme ve aksillayı korumaya yönelik yaklaşımlar gündeme gelmektedir.
Referanslar
Halsted WS. I. The Results of Radical Operations for the Cure of Carcinoma of the Breast. Annals of Surgery. 1907;46(1):1-19. doi:10.1097/00000658-190707000-00001.
Foroudi F, Tiver KW. Occult breast carcinoma presenting as axillary metastases. International Journal of Radiation Oncology,Biology,Physics. 2000;47(1):143-147. doi:10.1016/s0360-3016(99)00542-8.
Owen HW, Dockerty MB, Gray HK. Occult carcinoma of the breast. Surgery, Gynecology and Obstetrics Archives. 1954;98(3):302-308.
Walsh R, Kornguth PJ, Soo MS, et al. Axillary lymph nodes: mammographic, pathologic, and clinical correlation. AJR.American journal of roentgenology. 1997;168(1):33-38. doi:10.2214/ajr.168.1.8976915.
de Andrade JM, Marana HR, Sarmento Filho JM, et al. Differential diagnosis of axillary masses. Tumori. 1996;82(6):596-599. doi:10.1177/030089169608200617.
Copeland EM, McBride CM. Axillary metastases from unknown primary sites. Annals of Surgery. 1973;178(1):25-27. doi:10.1097/00000658-197307000-00005.
Gupta RK, Naran S, Lallu S, et al. R. Diagnostic value of needle aspiration cytology in the assessment of palpable axillary lymph nodes. A study of 336 cases. Acta Cytologica. 2003;47(4):550-554. doi:10.1159/000326567.
Blanchard DK, Farley DR. Retrospective study of women presenting with axillary metastases from occult breast carcinoma. World Journal of Surgery. 2004;28(6):535-539.doi: 10.1007/s00268-004-7290-y.
Namba N, Hiraki A, Tabata M, et al. Axillary metastasis as the first manifestation of occult breast cancer in a man: a case report. Anticancer Research. 2002;22(6B):3611-3613.
Selves J, Long-Mira E,Mathieu MC, et al. Immunohistochemistry for diagnosis of metastatic carcinomas of unknown primary site. Cancers(Basel). 2018;10(4):108. doi: 10.3390/cancers10040108.
Han JH, Kang Y, Shin HC, et al. Mammaglobin expression in lymph nodes is an important marker of metastatic breast carcinoma. Archives of Pathology & Laboratory Medicine. 2003; 127(10):1330-1334. doi: 10.5858/2003-127-1330-MEILNI.
Leygue E, Snell L, Dotzlaw H, et al. Mammaglobin, a potential marker of breast cancer nodal metastasis. The Journal of Pathology. 1999;189(1):28-33.
Watson MA, Dintzis S, Darrow CM, et al. Mammaglobin expression in primary, metastatic, and occult breast cancer. Cancer Research. 1999;59(13):3028-3031.
Sasaki E, Tsunoda N, Hatanaka Y, et al. Breast-specific expression of MGB1/mammaglobin: an examination of 480 tumors from various organs and clinicopathological analysis of MGB1-positive breast cancers. Modern Pathology. 2007;20(2):208-214. doi:10.1038/modpathol.3800731. Epub 2006 Dec 22.
O'Connell FP, Wang HH, Odze RD. Utility of immunohistochemistry in distinguishing primary adenocarcinomas from metastatic breast carcinomas in the gastrointestinal tract. Archives of Pathology & Laboratory Medicine. 2005;129(3):338-347. doi:10.5858/2005-129-338-UOIIDP.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Breast cancer. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.
UpToDate. Axillary node metastases with occult primary breast cancer. (Online). https://www.uptodate.com/contents/axillary-node-metastases-with-occult-primary-breast-cancer?search=occult%20breast%20cancer&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1. (07.03.2025 tarihinde ulaşılmıştır.)
Ju J, Zhu AJ, Yuan P. Progress in targeted therapy for breast cancer. Chronic Diseases and Translational Medicine. 2018;4(3):164-175.
Veer LJ, Dai H, Vijver MJ, et al. Gene expression profiling predicts clinical outcome of breast cancer. Nature. 2002;415(6871):530-536. doi: 10.1038/415530a.
Gradishar WJ, Anderson BO, Abraham J, et al. Breast cancer,version 3.2020, NCCN clinical practice guidelines in oncology. Journal of National Comprehensive Cancer Network. 2020;18(4):452-478. doi: 10.6004/jnccn.2020.0016.
Janicke F. Randomized adjuvant chemotherapy trial in high-risk, lymph node-negative breast cancer patients identified by urokinase-type plasminogen activator and plasminogen activator inhibitor type 1. Journal of The National Cancer Institute. 2001;93(12):913-920. doi: 10.1093/jnci/93.12.913.
Davidson NE, Abeloff MD. Adjuvant chemotherapy of axillary lymph-node-positive breast cancer. Adjuvant Ther Breast Cancer. 1992;978(1):3496-3499.
Merson M, Andreola S, Galimberti V, et al. Breast carcinoma presenting as axillary metastases without evidence of a primary tumor. Cancer. 1992;70(2):504-508.
Ofri A, Moore K. Occult breast cancer: Where are we at? Breast(Edinburg). 2020;54:211-215. doi:10.1016/j.breast.2020.10.012. Epub 2020 Oct 27
Cohen BL, Collier AL, Kelly KN, et al. Surgical management of the axilla in patients with occult breast cancer (cT0 N+) after neoadjuvant chemotherapy. Annals of Surgical Oncology. 2020;27(6):1830-1841.
Wang R, Yang HX, Chen J, et al. Best treatment options for occult breast cancer: A meta-analysis. Frontiers in Oncology. 2023;13:1051232. doi:10.3389/fonc.2023.1051232
Wang X, Zhao Y, Cao X. Clinical benefits of mastectomy on treatment of occult breast carcinoma presenting axillary metastases. The Breast Journal. 2010;16(1):32-37.
Varadarajan R, Edge SB, Yu J, et al. Prognosis of occult breast carcinoma presenting as isolated axillary nodal metastasis. Oncology. 2006;71(5-6):456-459. doi: 10.1159/000107111.
He M, Tang LC, Yu KD, et al. Treatment outcomes and unfavorable prognostic factors in patients with occult breast cancer. Europen Journal of Surgical Oncology. 2012;38(11):1022-1028.
Khandelwal AK, Garguilo GA. Therapeutic options for occult breast cancer: A survey of the American Society of Breast Surgeons and review of the literature. American Journal of Surgery. 2005;190(4):609-613.
Ellerbroek N, Holmes F, Singletary E, et al. Treatment of patients with isolated axillary nodal metastases from an occult primary carcinoma consistent with breast origin. Cancer. 1990; 66(7):1461-1467.
Ryu JK, Rhee SJ, Song JY, et al. Characteristics of quantitative perfusion parameters on dynamic contrast-enhanced MRI in mammographically occult breast cancer. Journal of Applied Clinical Medical Physics. 2016;17(5):377-390. doi: 10.1120/jacmp.v17i5.6091.
McCartan DP, Zabor EC, Morrow M, et al. Oncologic outcomes after treatment for MRI occult breast cancer (pT0N+). Annals of Surgical Oncology. 2017;24(11):3141-3147.
Ramírez Huaranga MA, Salas Manzanedo V, Huertas MP, et al. Lumbar pain as the single manifestation of an occult breast cancer. Usefulness of positron emission tomography. Reumatologia Clinica. 2015;11(2):118-120. doi: 10.1016/j.reuma.2014.02.009.
