A case of the breast cancer with intra mammary lymph node metastasiswhich was difficult to diagnose

A patient was 44-year-old-woman. She noticed a right breast mass 10 months ago. The mass got growth, so she visited our surgery. On the physical examination, two masses were palpable on the right upper outer quadrant. On the ultrasonography, two masses were detected as irregular hypoechoic area, so we suspected multiple breast cancer. We performed biopsy for larger mass and diagnosed invasive ductal carcinoma. We performed mastectomy and sentinel lymph node biopsy (SN). We performed SN with Radio colloid （99m-Tc) and Blue Dye. We dissected two axially sentinel lymph nodes （SLNs）, which was negative, and some lymph nodes around SLN （non-SLNs）. Pathologically, larger mass was diagnosed as papillotubular carcinoma. Because smaller one included lymph node component in the same film, it was diagnosed as an intramammary lymph node metastasis. One of non-SLN was also diagnosed as a metastasis. It is too difficult to have a preoperative diagnosis of intramammary lymph node metastasis. Generally, intramammary lymph node metastasis is a poor prognostic factor. Breast cancer with intramammary lymph node metastasis could spread to axial non-SLN metastasis, without axial SLN metastasis. We suggest that intramammary lymph node metastasis is an important factor of staging breast cancer.