Metastatic axillary lymphadenopathy of unknown primary can be a very challenging situation.
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Pathology
Usual potential sites include:
occult breast cancer: the incidence of an axillary lymph node manifestation from an occult primary breast cancer is low, ranging from 0.3-0.8% of all patients with carcinoma of the breast at presentation 1
occult lung cancer
occult malignant melanoma
occult head and neck malignancies
Radiographic work up
When a breast primary is suspected this is one of the indications for breast MRI.
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