A case of ectopic breast cancer with a literature review

A 63-year-old woman was referred to our hospital because of a right axillary nodule in 2004. Physical examination showed a spherical nodule measuring 0.5 cm in diameter in the right axilla. No mass was palpable in either breast. Mammograms were normal. Ultrasonography revealed a subcutaneous hypoechoic mass 0.7 mm in maximum diameter in the right axilla. The patient underwent an excisional biopsy. Histological examination revealed an invasive ductal carcinoma (scirrhous carcinoma) in ectopic breast tissue. The patient subsequently underwent a wide local excision of the tissue surrounding the biopsy scar, with axillary lymph node dissection. Histologically, no residual tumor or nodal metastasis was found. Postoperatively, she received endocrine therapy and remains well, without any evidence of recurrence 4 years 10 months after operation. Cancer of the ectopic breast tissue is rare, and most cases present as a solitary axillary mass. Long-term outcomes remain unclear. We present a case of breast carcinoma in the axillary ectopic mammary gland and summarize the clinical features of 94 cases, including ours, in Japan. We also compare long-term survival between ectopic breast cancer and usual breast cancer according to TNM T stage and lymph node metastasis.     

Sentinel lymph node mapping of a breast cancer of the vulva: Case report and literature review

Ectopic breast tissue is rare and typically presents as an axillary mass. Previous reports have identified ectopic breast tissue in the vulva, but malignancy is exceedingly uncommon. We present a 62 years old with locally advanced breast carcinoma arising in the vulva demonstrates the utilization of sentinel lymph node mapping to identify metastatic lymph nodes previously unable to be identified via traditional surgical exploration. Our case supports the principles of adjuvant therapy for breast cancer to be applied to ectopic breast cancer arising in the vulva. A literature review highlights common key points in similar cases to guide management.     

右侧副乳腺癌1例报道并文献复习

目的:探讨副乳腺癌手术方式的安全性和可行性。方法:我院近期对1例副乳腺癌患者行患侧乳腺、副乳腺及周围皮肤、皮下组织切除,同时清扫同侧腋下淋巴结的手术。结果:手术顺利完成。手术时间85min,出血量50ml。术后皮肤愈合良好,上肢活动正常。结论:该手术方式安全、可行。     

A case of occult contralateral breast cancer incidentally detected by contrast-enhanced mri; report of a case with review of literature

We encountered a case of occult contralateral breast cancer, previously undetected by conventional imaging such as mammography (MMG) and ultrasonography (US), but incidentally detected by contrast-enhanced magnetic resonance imaging (CE-MRI). We present it here with a review of the literature. A 67-year-old Japanese woman was referred to our hospital in October 2000 because of a 1.5 cm right breast lump detected in a medical checkup. MMG, US and fine needle aspiration cytology revealed a cancerous lesion during the right breast. No mass lesion was palpable nor was any detected by MMG or US in the left breast. Bilateral breast CE-MRI was performed for more detailed evaluation. Consequently, an occult contralateral breast cancerous lesion was detected incidentally by CE-MRI, with the images showing rapid initial enhancement of time to signal intensity curves. Before surgery, bilateral breast lesions were diagnosed as invasive ductal carcinoma by open biopsy. She underwent bilateral breast conserving surgery with bilateral axillary lymph node dissection. The postoperative course was uneventful and no recurrence has been noted as of January 18th, 2004. CE-MRI of the contralateral breast should be of value as a routine screen in those patients with a known or suspected malignancy in one breast considering the limits of breast cancer detection by such conventional modalities as MMG and US.     

Sudden hemorrhage of the breast caused by breast cancer: a case report and review of the literature

A rare case of sudden hemorrhage caused by breast cancer is reported. A 71-year-old woman noted bleeding from her left breast. Physical examination of the left breast showed a localized open cavity accompanied by bleeding and coagulation. The patient had no history of breast trauma or anticoagulation therapy. Incisional biopsy followed by histological examination resulted in a diagnosis of granulation tissue with no cancer cells present. Mammography and ultrasonography indicated probable breast cancer. As a result, a second incisional biopsy was performed, which suggested invasive ductal carcinoma without histological skin invasion. A modified radical mastectomy was performed under a diagnosis of stage II breast cancer. Breast cancer with sudden hemorrhage is rare. We review the literature and discuss the cause of this unusual manifestation.     

Cervical cancer metastatic to the breast: a case report and review of the literature

Metastasis to the breast from primary cervical cancer is rare. We describe one such patient, who developed breast metastasis 6 months after diagnosis. She was free of pelvic disease at the time of metastases but had evidence of lung involvement. She died of progressive disease 2 months later. Data on 23 patients collected from the literature via Medline are reviewed.     

Paclitaxel-induced pneumonitis in patients with breast cancer: case series and review of the literature

Doxorubicin plus cyclophosphamide followed by paclitaxel is a common adjuvant treatment for high-risk breast cancer. It has been associated with pulmonary toxicity in several case reports. We describe three patients in whom interstitial pneumonitis developed immediately after the first paclitaxel exposure and worsened clinically over time. All reported dyspnoea, fever and progressive respiratory distress. Imaging revealed diffuse bilateral pulmonary infiltrates. Other causes of respiratory failure were excluded with laboratory work-up, imaging, biopsy studies and results of antibiotic treatment. The respiratory decline was reversed only after administration of high-dose steroids, an empirical treatment previously reported to be beneficial in similar cases. Although chemotherapy using concomitant or sequential drugs may make identification of the toxic agent difficult, we noted a clear temporal relationship between exposure to paclitaxel and the development of pulmonary toxicity. Furthermore, according to the available literature, it is less likely that a respiratory decline would be caused by either cyclophosphamide or trastuzumab. In conclusion, clinicians should be aware of the potentially life-threatening risk of pulmonary toxicity following paclitaxel treatment. If paclitaxel is halted early and the patient has good lung reserve, pulmonary toxicity can be reversed with high-dose steroid administration.     

Lipid-secreting carcinoma of the breast: A case report and review of the literature

A case of lipid-secreting carcinoma in the right breast of a 78-year-old Japanese woman is reported. Light microscopy revealed solid alveolar proliferation in the majority of tumor cells, which had abundant foamy cytoplasm. A variable amount of neutral lipid was identified in the cytoplasm of the tumor cells by Sudan III staining and electron microscopy. This case is reported along with a discussion of other cases of lipid-secreting or lipid-rich carcinoma that have been reported in the international literature.     

Total vertebral body breast cancer metastases: one case report and literature review

Introduction
Breast cancer is one of the most commonly seen malignant tumors in the female population, and it ranks the first in the incidence of malignancies among women. The skeleton is a common metastatic site for advanced breast cancer and is where spinal metastasis is most frequently seen. The incidence rate of spinal metastasis in descending order is as follows： thoracic vertebrae, lumbar vertebrae, sacrococcygeal vertebrae and cervical vertebrae.     

Ectopic breast tissue in axillary lymph node

Benign epithelial inclusions are uncommonly found in lymph nodes, and ectopic breast tissue in axillary lymph nodes is particularly uncommon. The patient is a 48-year-old woman who had an adenoma of the nipple removed 10 years previously. A swollen lymph node with amorphous calcifications in a clustered distribution on mammogram was found in the left axilla. Fine needle aspiration cytology showed only cystic change. Excisional biopsy was performed and microscopic examination demonstrated that the node contained benign mammary epithelial and glandular inclusions, and no evidence of malignancy. Such cases will be increasingly found due to the widespread use of mammography screening and biopsy of axillary sentinel lymph nodes. Ectopic breast tissue in lymph nodes may be mistaken for malig-nant lesions. It is most important to identify correctly the epithelial inclusions in lymph nodes to prevent an erroneous diagnosis.     

Forequarter amputation for recurrent breast cancer: a case report and review of the literature

Axillary recurrence of breast cancer is an uncommon event that can lead to debilitating pain, lymphedema, and paralysis of the upper extremity. Multimodality therapy including surgery is usually used to control local recurrence. In a subset of patients, the extent of disease is such that local excision of the recurrence is not possible. In the absence of metastatic disease, forequarter amputation may be used as an effective means of surgical salvage and palliation for locally recurrent breast cancer. In this report, we describe management of a patient with advanced axillary recurrence treated with forequarter amputation and review the current literature on the use of this operation in breast cancer patients.     

Neoplasms in skin and subcutis over the breast, simulating breast neoplasms: case reports and literature review

Twenty cases of neoplasms in skin and subcutaneous tissue over the breast were reviewed. There were 17 women, from 15 to 70 years of age, and three men, from 25 to 66 years of age. Among the benign skin neoplasms, superficial leiomyoma, granular cell tumor, and eccrine acrospiroma were misdiagnosed clinically as primary breast carcinoma. Among the malignant neoplasms in subcutaneous tissue, there were three metastatic malignant melanomas, one metastatic epidermoid bronchogenic carcinoma, and two malignant lymphomas. It is interesting that four of these six patients had no prior history of malignant lesion, the subcutaneous nodule presenting as the first manifestation of an occult primary. It is concluded that histological diagnosis of such tumors may lead to avoidance of unnecessary radical surgery.     

Angiosarcoma of the breast: the experience of the European Institute of Oncology and a review of the literature

Angiosarcoma of the breast (AB) is a rare entity: its overall incidence is estimated at between 0.002% and 0.005% per year. Some potential risk factors have been described, mainly previous irradiation of the breast. We report the experience of the European Institute of Oncology with this unusual disease from January 1996 to January 2006: sixteen patients with angiosarcoma, 9 (56%) of whom had primary AB and 7 (44%), secondary AB, are discussed.     

Erythema nodosum secondary to aromatase inhibitor use in breast cancer patients: case reports and review of the literature

Aromatase inhibitors (AI’s) are increasingly being incorporated in the treatment strategy for hormone receptor positive breast cancer either alone or in combination with chemotherapy, biologics in both the adjuvant and metastatic setting [1]. They markedly suppress plasma estrogen levels by inhibiting or inactivating aromatase, the enzyme responsible for the synthesis of estrogens from androgenic substrates [1]. Currently, the three selective aromatase inhibitors that are available are anastrozole, letrozole and exemestane which reduce circulating estrogen to 1 to 10% of pretreatment levels [2]. For advanced breast cancer, aromatase inhibitors appear to be at a minimum, equivalent and perhaps even better than tamoxifen in the first line setting [3, 4]. In primary breast cancer, adjuvant therapy with anastrozole or letrozole appears to be superior to tamoxifen in reducing the risk of relapse [5, 6]. Common adverse effects associated with AI’s include arthralgias (21%), myalgias (12%), other musculoskeletal disorders (28%) and an up to 60% increased risk of bone fracture [7, 8]. However, anastrozole, exemestane and letrozole are associated with significantly fewer endometrial cancers, as well as venous and arterial vascular events, when compared with tamoxifen [9, 10]. Very rarely letrozole and anastrozole can cause a skin rash; the frequency of its occurrence has not been quantified^. However, exemestane has not been reported to cause a skin rash [11]. To date, erythema nodosum (EN) has not been reported as a dermatologic side effect of AI’s. Here, we report three cases of EN which developed in postmenopausal breast cancer patients on AI’s.     

Liposarcoma of the breast arising in a malignant phyllodes tumor: A case report and review of the literature

Liposarcoma of the breast is a very rare malignant tumor. It can clinically manifest as a palpable breast mass and mimic primary breast cancer. We report an unusual case of a 51-year-old female who presented with an asymptomatic right breast mass, which was histologically diagnosed as well differentiated liposarcoma arisen within malignant phyllodes tumor. The patient underwent breast conserving surgery, received no adjuvant treatment and is disease-free after 2 years. Radiological and histopathological features are presented and described in detail. Data from the literature are presented and therapy recommendations discussed.     

Anti-Ri antibody opsoclonus-myoclonus syndrome and breast cancer: a case report and a review of the literature

Opsoclonus-myoclonus is a rare neurological paraneoplastic syndrome associated with breast cancer and the presence of anti-Ri antibody. We presented a case of a 79-year-old woman with this syndrome and a small invasive ductal carcinoma [pT1aN0(sn)M0], whose symptoms improved 3 months following her simple mastectomy without any adjuvant therapy. Based on the 15 previously reported cases in the literature, there is no uniform treatment option available, and the response to such treatments is mixed.     

Psycho-social aspects of breast cancer susceptibility testing: a literature review

An important demand for breast cancer susceptibility (BRCA) testing is anticipated not only in women at high risk of breast cancer but also in the general population. However, the benefits of this new technology may be substantially counterbalanced by the risks and limitations associated with it. BRCA testing offers the potential for early detection of breast cancer; however, it may lead to psycho-socially harmful consequences. Both carriers and non-carriers of a BRCA mutation may face tremendous emotional upheaval which may adversely impact on subsequent attitudes towards health care. This paper points to the need for empirical studies examining the psycho-social aspects of BRCA testing. These studies should be undertaken cross-culturally in order to take into account the variations due to different health care systems and cultural background on psycho-social correlates of cancer genetic testing.