We report four occult carcinoma breast cases in which extensive axillary node metastases was the first manifestation. Upper outer quadrentectomy with axillary dissection was done in three patients while modified radical mastectomy was done in one. Primary tumor could be found in three patients, one had squamous cell carcinoma (SCC) & two had infiltrating duct carcinoma (IDC). However primary tumor was not detected in breast tissue of the fourth patient. Extensive lymph node metastases were found in three out of 14,15 out of 15(SCC), 24 out of 24 and 1 out of three axillary nodes respectively. Results of immunohistochemical staining for estrogen and progesterone receptors on three cases were negative. All patient received postoperative radiotherapy and chemotherapy. We have reviewed the literature and discussed the approach to diagnosis and management in female patients presenting with metastatic carcinoma in the axillary nodes with emphasis on the appropriate pre-treatment evaluation.