Secretory carcinoma of the breast is a rare tumor which has unique pathological features such as large amount of intracellular and extracellular secretian and granular eosinophilic cytoplasm. Moreover axillary nodal metastasis at initial presentation is a rarer conditian. We report a case of secretory carcinoma of the breast with axillary nodal metastasis which occurred in a 29-year-old woman. The involved breast was radiologically unremarkable but enlargement of ipsilateral axillary lymph node was demonstrated. Cytological examination of nipple discharge and ultrasound guided fine needle aspiration biopsy of axillary nodal lesion were diagnosed as ductal carcinoma and metastatic carcinoma of axillary lymph node from primary breast cancer. Traditionally surgery has been standard treatment and extended simple mastectomy was the most appropriate treatment. In this case axillary nodal metastasis was unusual presentation, and modified radical mastectomy (Patey's operation) with axillary node dissection was performed. Final histopathological examination confirmed secretory carcinoma with invasion of underlying fascia and metastatic axillary lymph nodes, all the three removed nodes. Postop- erative radiotherapy and systemic multiagents chemotherapy were administered. To our knowledge this is the first case of a secretory carcinoma in our institution and we re- port this case with review of literature.
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