Misleading images of ductal carcinoma in situ: 4 lymph nodes with metastasis / Imágenes equívocas de carcinoma ductal in situ: 4 ganglios linfáticos con metástasis

Since sentinel lymph node examination became routine, findings of benign ectopic breast tissue in lymph nodes have increased. We report images of ductal carcinoma in situ (DCIS) in four lymph nodes in a 76-year-old woman with bilateral breast carcinoma. The right lumpectomy showed intermixed invasive lobular and ductal carcinoma, plus DCIS. 19 nodes were isolated in the axillary lymphadenectomy, 4 of which displayed solid and cribriform DCIS. Myosin and p63 immunohistochemical techniques were positive, suggesting an erroneous diagnosis of “metastatic DCIS”. A further three cases of DCIS in lymph nodes have been previously reported, all with a distinct layer of myoepithelial cells with actin, myosin or p63. Biologically, these images of DCIS in lymph nodes are not credible and three major hypotheses have been proposed to explain these findings: Iatrogenic Mechanical Transport, Revertant DCIS, and primary DCIS of lymph nodes. We consider the first one the most plausible explanation. Our case is unique as several, rare findings are simultaneously observed. More new cases, together with additional immunohistochemical techniques and molecular testing on previous cases, are needed to find a definitive explanation of this histologic finding.(AU)

A partir del uso rutinario del examen del ganglio centinela, los hallazgos de tejido mamario ectópico son frecuentes. Presentamos los hallazgos de carcinoma ductal in situ (CDIS) en 4 ganglios linfáticos en una mujer de 76 años con carcinoma de mama bilateral. La lumpectomía derecha mostró una mezcla de patrones de carcinomas ductal y lobular infiltrante, además de CDIS. De los 19 ganglios aislados, 4 mostraron patrones cribiformes y sólidos de CDIS. La miosina y la p63 fueron positivas, sugiriendo un diagnóstico erróneo de «CDIS metastático». En la literatura se han comunicado 3 casos adicionales de patrones de CDIS en ganglios linfáticos, mostrando capa periférica de células mioepiteliales positivas para actina, miosina o p63. Desde un punto de vista biológico, estos hallazgos de CDIS en ganglios linfáticos son discutibles, proponiéndose 3 hipótesis para explicarlo: transporte mecánico yatrogénico, CDIS revertido y CDIS primario de ganglio linfático. Creemos que la primera alternativa es la más plausible. Nuestro caso es único al mostrar, de modo conjunto, diversos hallazgos infrecuentes. El estudio de nuevos casos, así como la aplicación de técnicas inmunohistoquímicas y moleculares a casos de archivo, arrojarían datos que permitirían llegar a una explicación definitiva de este hallazgo histológico.(AU)

Misleading images of ductal carcinoma in situ: 4 lymph nodes with metastasis.

Since sentinel lymph node examination became routine, findings of benign ectopic breast tissue in lymph nodes have increased. We report images of ductal carcinoma in situ (DCIS) in four lymph nodes in a 76-year-old woman with bilateral breast carcinoma. The right lumpectomy showed intermixed invasive lobular and ductal carcinoma, plus DCIS. 19 nodes were isolated in the axillary lymphadenectomy, 4 of which displayed solid and cribriform DCIS. Myosin and p63 immunohistochemical techniques were positive, suggesting an erroneous diagnosis of "metastatic DCIS". A further three cases of DCIS in lymph nodes have been previously reported, all with a distinct layer of myoepithelial cells with actin, myosin or p63. Biologically, these images of DCIS in lymph nodes are not credible and three major hypotheses have been proposed to explain these findings: Iatrogenic Mechanical Transport, Revertant DCIS, and primary DCIS of lymph nodes. We consider the first one the most plausible explanation. Our case is unique as several, rare findings are simultaneously observed. More new cases, together with additional immunohistochemical techniques and molecular testing on previous cases, are needed to find a definitive explanation of this histologic finding.

Giant Lipoma of the Arm Masquerading as an Accessory Breast: A Report of a Rare Case.

Accessory breast is an extremely rare condition that develops in 0.4%-6% of females. It is primarily found in the axilla and is frequently misdiagnosed. It is usually bilateral and manifests during pregnancy or lactation as an asymptomatic tumor. The diagnosis of ectopic breast tissue is crucial because it is capable of undergoing the same pathological changes as normal breast tissue, including mastitis, fibrocystic changes of the breast tissue, and, in extreme cases, even malignancy. We present the case of a 40-year-old female who presented with swelling in the left upper arm for the past eight years, which was associated with pain. Initially, accessory breast was kept as the clinical diagnosis. However, further imaging and histological analysis revealed it to be a giant lipoma of the upper arm.

Ectopic primary ductal breast carcinoma of the vulva: a case report and literature review.

Background: Ectopic breast tissue (EBT) is normally found along the rudimentary mammary line, which is located from the axilla to the inguinal region and disappears during embryogenesis. Up to 6% of females around the world suffer from EBT. EBT cancer is rare, with only a few reports in the literature. The diagnosis, and treatment of these rare cases can be very difficult and complex. Case presentation: The authors report an interesting case of a 74-year-old female patient with a vulvar lump located on the mons pubis associated with ulceration, pain, and size increase. The histopathological study demonstrated an invasive ductal carcinoma grade 2 arising from EBT in the vulva. Within 4 months of follow-up, the patient's condition was stable. Clinical discussion and conclusions: Throughout this paper, the authors aim to highlight the diagnostic and therapeutic challenges since there are no current guidelines for treatment for such cases. Furthermore, this article describes this rare disease and includes surgical details, difficulties, diagnostic methods, and treatment options.

Unilateral Ectopic Breast Tissue in the Vulva - A Diagnostic Dilemma.

Ectopic breast tissue is a rare condition caused by remnants of the mammary ridges that fail to involute during embryologic development. Clinical presentation of vulval breast tissue is highly variable and diagnosis is ultimately made by tissue biopsy and histopathological examination. Since this ectopic tissue serves no function, surgical excision is recommended. Vulval ectopic breast tissue is an extremely rare case, especially in midlife. Because of its rarity in occurrence and unusual site, here we report a case of unilateral ectopic breast tissue on the vulva in an adult midlife female.

Perineal fibroadenoma masquerading as a soft-tissue sarcoma: a case report.

We report a case of a perineal fibroadenoma initially diagnosed on ultrasound and magnetic resonance imaging as a soft tissue sarcoma in a 35-year-old female. Following wide local excision, histopathology revealed the lesion as a vulval fibroadenoma. We provide an overview of the literature and highlight the need to consider fibroadenoma, arising from ectopic breast tissue, as an important differential for general surgeons and gynaecologists caring for patients with perineal masses.

Fibroadenoma Arising in Axillary Ectopic Breast Tissue. A Diagnostic Challenge.

Ectopic or accessory breast tissue may occur in primitive embryonic milk lines or locations other than the milk line. The same pathology arising in breast tissue may occur less frequently in ectopic breast tissue. Fibroadenomas rarely occur in ectopic breast tissue, with less than 50 reported cases in the English literature, despite being the most common benign breast neoplasms. Diagnosing fibroadenoma in ectopic breast tissue can be challenging due to the lack of clinical suspicion and the atypical findings in imaging studies. Treatment consists of surgical excision. In this manuscript, we present a case of a 24-year-old patient with a fibroadenoma of the left axilla arising in bilateral axillary ectopic breast tissue, and we comprehensively review the literature.

Primary Ectopic Breast Carcinoma in Man Mimicking Keloid.

Background: Ectopic breast tissues (EBT) are developmental abnormality found in 1-6% of normal population. Like an orthotopic breast tissue, ectopic breast may have similar pathological changes including malignancy. Breast cancer as well as ectopic breast tissue in male are extremely rare. We present a case of ectopic breast carcinoma (EBC) in middle aged man mimicking keloid. Case report: A forty-two-year-old Indo-Aryan male referred from primary health care to the dermatology clinic with firm multi-nodular, non-tender, fleshy sessile mass on his right axilla measuring two by three cm in diameter. Excision of this lesion revealed moderately differentiated ductal carcinoma consistent with ectopic breast carcinoma. Conclusion: We report this case to shed light on such a rare condition and to keep in mind that ectopic breast carcinoma should be in differential diagnosis of any suspicious mass in axillae.

Primary ectopic breast carcinoma arising in the inguinal region in a male patient.

Carcinoma arising in ectopic breast tissue is a rare entity, especially in males, in whom the diagnosis is often delayed due to a low index of suspicion. Conventional imaging techniques fail to characterize the tumor, adding further to the diagnostic dilemma. We report the first case in our knowledge of an extramammary primary breast carcinoma arising in the inguinal region in a male. Our patient, a 69-year-old male, presented with a swelling in the left inguinal region, which was excised and diagnosed as luminal A type invasive ductal carcinoma. He received adjuvant external beam radiotherapy (50 Gy administered in 25 fractions) and tamoxifen. A follow-up examination performed 6 months after the completion of the last dose of radiotherapy showed no residual disease. The modalities of treatment for such tumors have been discussed, with emphasis on surgery and radiotherapy, given the aggressive nature of the disease.

Invasive Lobular Carcinoma Arising in Ectopic Breast Tissue: A Case Report.

Incomplete regression of the embryonic mammary line occurs in 0.3-6% of the population. Ectopic breast tissue is mostly asymptomatic and can undergo malignant transformation. Ectopic breast cancer accounts for 0.2-0.6% of all breast cancers. Screening breast examinations can miss these lesions due to their location making the diagnosis more challenging. We describe a case of a primary invasive lobular carcinoma in an ectopic breast on the left axilla detected in a 49-year-old woman. Firstly diagnosed as a sebaceous cyst, the lesion was excised under local anesthesia. Histopathology showed breast tissue widely infiltrated by an invasive carcinoma. Excision of the remnant tissue with axillary lymph node dissection was performed. Ectopic breast carcinoma is a rare diagnosis and there is a general lack of awareness. The presence of an abnormal mass along the mammary ridge should raise clinicians' attention. Management of primary ectopic breast carcinoma should be based on a multidisciplinary approach under the same principles as breast cancer. Furthermore, it does not appear to bring a worse prognosis when diagnosed at similar disease stages.

Fibroadenoma in vulval ectopic breast tissue in a patient with PTEN Hamartoma Tumour Syndrome.

PTEN is a tumour suppressor gene involved in regulating cell division. Pathogenic germline variants in PTEN predispose to benign and malignant growths of numerous organs, including of the breast. In the following report, we describe the first documented case of a fibroadenoma developing in ectopic breast tissue of the vulva in a patient with a germline pathogenic variant in PTEN. This highlights the risk of hyperplasia developing in any breast tissue, including rare ectopic sites, particularly in patients with underlying germline variants in cancer susceptibility genes.

Cutaneous Periumbilical Fibroadenomas: A Rare Case of Ectopic Breast Tissue.

Ectopic breast tissue is the presence of retained breast tissue along the embryologic mammary ridge, also known as the milk line. Accessory tissue can be located anywhere along or outside the anatomic milk line extending from the axilla to the groin. Ectopic breast tissue can undergo the same physiologic and pathologic changes seen in normal breast tissue, such as fibroadenomas, fibrocystic changes, and malignancy. The wide range of clinical presentations and symptomatology can pose a significant diagnostic challenge, and clinicopathologic correlation is key in establishing the diagnosis. In this report, we review the clinical and histopathologic findings in a rare case of cutaneous periumbilical fibroadenomas in a 25-year-old female.

Bilateral axillary tumour in a 12-year-old girl: a case report .

BACKGROUND: Ectopic breast tissue is a rare condition in the Caucasian population. The most frequent form is polythelia (supernumerary nipples), whereas polymastia (complete supernumerary breasts) is more uncommon. They are usually benign asymptomatic lesions that go undetected until pregnancy or lactation. However, they are under the same hormonal influence as normal breast tissue and therefore are susceptible to malignant changes. CASE:   a 12-year-old girl presented bilateral axillary polymastia and polythelia, detected with puberal changes. Surgical removal was postponed until the end of puberal development. SUMMARY AND CONCLUSIONS: Polymastia is a rare condition that can have psychological consequences, especially in adolescents. It has been associated with other malformations and malignant tumours, so surgical removal is usually recommended.

Primary ectopic axillary breast cancer: a case series.

INTRODUCTION: Ectopic breast tissue is present in 2-6% of women. Ectopic breast cancer represents an uncommon disease accounting for about 0.3% of all breast neoplasms, limiting the available evidence. Thus, we aim to report long-term outcomes in five cases treated at our institution. CASE SERIES: Our Tunisian patients' median age was 48 years (33-60 years), and the median follow-up was 8 years (4-10 years). The ectopic breast tissue was located four times in the right axilla. The median tumor size was 25 mm (15-55 mm). Four of the patients underwent a wide local excision and axillary lymph node dissection. Three of those women had positive lymph nodes; thus, they received adjuvant chemotherapy, radiation therapy, and hormone therapy. The patient with a negative lymph node (case 5) had adjuvant radiation therapy and hormonal therapy. One of the patients (case 1) had a positive supraclavicular lymph node and received radiation therapy, chemotherapy, and hormonal therapy. The latter developed a locoregional relapse after 4 years and was treated with mastectomy and chemotherapy. One patient (case 4) had a distant metastasis after 2 years of follow-up and received chemotherapy. The three other patients were free of relapse during their follow-up period. CONCLUSION: Primary axillary breast carcinoma is a rare entity. Despite the paucity of literature, our findings and authors' recommendations suggest that local excision can be performed safely with promising outcomes in this subset of patients.

Ectopic axillary breast cancer in a male patient.

Ectopic breast tissue can persist in the axilla due to lack of involution of mammary glands along the mammary lines. It is rare in men, and the malignant transformation to breast cancer has occasionally been described. Differential diagnosis of any axillary tumor should include breast cancer arising at ectopic sites.

Pregnancy-unrelated fibroadenoma in ectopic breast tissue in the axilla and vulva: A case report.

Although ectopic breast tissue is rare in the general population, it is important to consider when investigating an axillary or vulvar mass. Ectopic breast tissue most commonly occurs postpartum but is not exclusive to that period. We report the case of a 29-year-old woman with ectopic breast tissue in multiple sites, including the axilla and vulva. The patient initially presented with a painless right axillary mass; it was excised and diagnosed as a fibroadenoma. She was then diagnosed with fibroadenoma of the vulva four years later. While ectopic breast tissue is most commonly found in the postpartum period it can occur outside of pregnancy. Therefore it should be included in the differential diagnoses for axillary or vulvar masses. Additionally, it is important to monitor women with ectopic breast tissue, particularly in the vulva, for recurrence.

A Rare Presentation of an Invasive Ductal Carcinoma of Ectopic Axillary Breast Tissue.

Ectopic breast tissue (EBT) is a rare entity and can present anywhere along the milk line, including the axilla, inframammary region, thighs, perineum, groin, and vulva. However, the axilla is the most common area of presentation. EBT can present as supernumerary breasts or aberrant breast tissue. Malignancy arising in EBT is rare, but the most common morphological variant is invasive ductal carcinoma. We report a case of a 43-year-old woman, a smoker with a family history of breast cancer, who presented to our clinic with a small mass in the right axillary area. After monitoring it for one year, the mass increased in size, so she returned to the clinic and decided with her care team to excise the mass. Histopathology showed invasive mammary adenocarcinoma arising in EBT and was diagnosed as right accessory stage I breast cancer. This case illustrates the imperative that any mass in the axillary region should be thoroughly assessed to rule out carcinoma in the accessory axillary tissue for timely management.