Background: Carcinoma of the breast is the most commonly diagnosed women cancer. Less than 1% of the patients diagnosed with breast cancer initially present with axillary metastases as their only clinical manifestation. Casuistic: We report case of 58 years old woman with occult breast carcinoma in which extensive axillary node metastasis was the first manifestation. Discussion: Breast cancer presenting with axillary metastases and no clinical apparent primary tumour in the breast is an uncommon form of stage II or IV of this disease. Ultrasonography, mammography, MRI and excisional biopsy are indicated for detecting occult primary tumours. The appropriate treatment of the breast after an axillary presentation of occult breast carcinoma continues to be a controversial issue. Complete axillary lymph node dissection is indicated in all patients. As a local treatment of the breast is indicated irradiation of the breast or total mastectomy or subcutaneus mastectomy with application of the breast prothesis. Conclusion: Axillary metastasis is rare first sign of breast cancer. Diagnostics of the occult breast carcinoma is difficult. The treatment of occult breast carcinoma is still controversial.

        Key words: occult breast cancer – axillary metastasis – mamography – ultrasound of the breast – MRI – excisional biopsy – controversial treatment