Case Study: Supraclavicular nodules in females: May be primary duct carcinoma

Summary

A 47-year-old female presented with recent weight loss, loss of appetite and general weakness. Left supraclavicular nodules were palpable and aspiration smears were inconclusive. Trucut biopsy from the lesion confirmed primary duct carcinoma.

Background

Duct carcinoma in females generally presents as an immobile non-tender intra-mammary lump. Any nodules outside the breast tissue in these patients are regarded as secondary deposits. Primary carcinomas of the axillary tail of the breast or axillary breast tissue are reported, but primary duct carcinoma is still not known to arise de-novo in ectopic breast tissues in the supraclavicular or neck region.

Case Presentation

A 47-year-old female presented with recent weight loss, loss of appetite and general weakness. Her routine hemogram, chest X-ray, liver function tests and abdominal ultrasonography were normal. Bilateral breasts contained no lumps, and the axillae were normal. Only the left supraclavicular region revealed 3 to 4 firm, discrete, immobile nodules which were non-tender.

Investigations

• Routine hemogram to rule out leukemia
• Chest X-ray, Monteux test, Sputum for AFB to rule out malignancy and tuberculosis
• Liver function tests and abdominal ultrasonography to rule out gastrointestinal pathology
• Mammography to rule out breast tumor
• FNAC to rule out malignancy and tuberculosis (inconclusive in this case)
• Trucut biopsy for the confirmatory diagnosis

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