Breast cancer presenting as axillary abscess and unilateral lymphedema

Introduction

This is a case report illustrating the initial presentation of breast cancer as an axillary abscess and ipsilateral arm lymphedema.

Case report

A 62-year-old Indian lady presented with the main complaints of left arm swelling and pain of 6 months duration. Clinical examination revealed gross right upper limb lymphedema; associated with tender axillary abscess with possibility of infected lymphadenopathy. Right breast examination revealed multifocal hard breast lumps with a retracted nipple. Ultrasound and mammography of the breasts showed an edematous right breast with several suspicious nodules. As the patient was septic and symptomatic from the axillary abscess, we performed an axillary drainage and axillary lymph node biopsy, which proved positive for adenocarcinoma. Ultrasound-guided core biopsy of the breast lesion was invasive ductal carcinoma. The estrogen and progesterone receptors were negative, c-erb2 was positive. Metastatic work-up showed that the patient had bilateral pulmonary metastases with bony metastases as well.

Conclusion

The present case highlights the fact that, despite a breast screen programme established in Singapore, there are patients presenting with locally advanced cancers. This case is particularly interesting as she presented as a surgical emergency for an axillary abscess.