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Barrios M, Perez NE, Briski LM, Pluguez-Turull C. Recurrent ectopic primary breast adenocarcinoma of the vulva with a 19-year follow-up period. BMJ Case Rep 2024; 17:e257791. [PMID: 38367988 PMCID: PMC10875544 DOI: 10.1136/bcr-2023-257791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
We present a case of an ectopic breast adenocarcinoma of the vulva with metastatic local recurrence and a total follow-up period of 19 years, the longest documented in the literature to our knowledge. Following surgical excision, radiation therapy and hormonal treatment after the recurrence, the patient has remained disease free. This case demonstrates the potential for malignant transformation in accessory breast tissue and highlights the importance of close surveillance and regular physical examinations in patients with a history of ectopic breast malignancy.
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Affiliation(s)
- Mirelys Barrios
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nathalie E Perez
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Laurence M Briski
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Cedric Pluguez-Turull
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
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2
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Mansour M, Zahra O, Nabulsi D, Alhamwi A, Chahin M, alani WR, Yousef D, Kanbour I, Kurdi B, Mohammad Deeb A. Ectopic primary ductal breast carcinoma of the vulva: a case report and literature review. Ann Med Surg (Lond) 2023; 85:5138-5144. [PMID: 37811111 PMCID: PMC10553189 DOI: 10.1097/ms9.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
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.
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Affiliation(s)
- Marah Mansour
- Department of Colorectal Surgery, Mayo Clinic, Rochester, MN
- Faculty of Medicine, Tartous University, Tartous
| | - Orgwan Zahra
- Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Dalia Nabulsi
- Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | | | | | | | - Diaa Yousef
- Faculty of Medicine, Aleppo University, Aleppo
| | - Ilda Kanbour
- Department of Gynecology, Obstetrics University Hospital, Damascus
| | - Bashar Kurdi
- Department of Gynecology, Obstetrics University Hospital, Damascus
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3
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Buitrago-Flechas SM, Barrera-Latorre SJ, Morante-Caicedo C. Ectopic mammary tissue in vulva: case report and systematic literature review. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2021; 72:271-290. [PMID: 34851570 PMCID: PMC8629372 DOI: 10.18597/rcog.3593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/04/2021] [Indexed: 11/26/2022]
Abstract
Objective To report the case of a patient diagnosed with ectopic mammary tissue in the vulva, and to conduct a literature review of the diagnosis, treatment and prognosis of this condition in that location. Materials and Methods A 49-year-old patient who presented with a painful vulvar mass to a private intermediate complexity center in Bogotá, Colombia. The lesion was assessed on ultrasound and then surgically excised; histopathology showed ectopic mammary tissue with absence of malignancy. A search was conducted in the PubMed, Embase, Cochrane, LILACS and Scielo databases using the keywords “Vulva,” “Breast” and “Ectopic.” Case reports and case series of women with histopathology-confirmed mammary tissue in the vulva were included. Results Overall, 184 titles were identified and, of these, 94 were ultimately included, for a total of 126 cases, with 57.9% being benign tumors, 95% in women under 50 years of age, and 42.06% being malignant tumors, 92% in women over 50 years of age. Diagnosis was made on the basis of the clinical findings, with ancillary diagnostic imaging, tumor markers and immunohistochemistry in some cases. Local excision was performed in 91% of cases with benign pathology and in 43% of cases with malignant pathology, with the diagnostic method being therapeutic. Conclusions Ectopic mammary tissue in the vulva must be considered as part of the differential diagnosis of vulvar masses, prognosis being different in pre and postmenopausal women. Further studies are needed to enhance the characterization of this condition and define the ideal course of treatment in terms of relapse and survival.
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Shahiri P, Dillon AH, French V. Fibroadenoma Presenting as a Vulvar Mass. Kans J Med 2020; 13:322-323. [PMID: 33343827 PMCID: PMC7735430 DOI: 10.17161/kjm.vol13.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Parmida Shahiri
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS
| | - Anna Heimes Dillon
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Valerie French
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS
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5
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Konstantinova AM, Kazakov DV. Extramammary Paget disease of the vulva. Semin Diagn Pathol 2020; 38:50687. [PMID: 32921571 DOI: 10.1053/j.semdp.2020.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023]
Abstract
Extramammary Paget disease (EMPD) is a rare neoplasm with uncertain histogenesis, usually presenting in the anogenital area, most commonly in the vulva. The disease is characterized by slow grow and high recurrence rates. This article reviews the epidemiological, clinical, morphological, genetic and treatment features of EMPD of the vulva reported in recent years.
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Affiliation(s)
- Anastasia M Konstantinova
- Department of Pathology, Clinical Research and Practical Center for Specialized Oncological care, Saint-Petersburg, Russian Federation; Department of Pathology, Medical Faculty, Saint-Petersburg State University, Russian Federation; Department of Pathology, Saint-Petersburg Medico-Social Institute, St.-Petersburg, Russian Federation
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic; Bioptical Laboratory, Pilsen, Czech Republic.
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6
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Ananthula A, Lockwood B, Savage J, Malak S, Chen C, Makhoul I, Pennisi A. Primary Breast Carcinoma of the Vulva Metastatic to Lymph Nodes and Bones: A Case Report and Literature Review. Perm J 2020; 24:19.084. [PMID: 32097114 DOI: 10.7812/tpp/19.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Primary breast carcinoma can occur at ectopic sites. The axilla is the most common site of ectopic primary breast cancer, but presentation in the vulva is rare. We discuss a rare presentation of primary breast carcinoma of the vulva with distant lymph node and bone metastases in a premenopausal woman. CASE PRESENTATION A vulvar malignancy consistent with adenocarcinoma of the mammary gland type was diagnosed in a 47-year-old premenopausal woman. The patient underwent radical vulvectomy with bilateral superficial and deep inguinal lymphadenectomy. The tumor was positive for estrogen receptor and negative for progesterone receptor and human epidermal growth factor receptor 2/neu on immunohistochemical findings. A positron emission tomography-computed tomography scan demonstrated lymph node and bone metastases. Her disease was treated as stage IV breast cancer with metastases to the bone. Palliative treatment with ovarian suppression, aromatase inhibitor, and cyclin-dependent kinase 4/6 inhibitor was recommended. DISCUSSION For a diagnosis of primary breast cancer of the vulva, a thorough metastatic workup should be performed, with attention directed toward detecting a breast primary disease by results of the history, physical examination, and radiologic examination of the breasts mainly to help confirm that the vulvar lesion is the primary site as opposed to metastasis from a breast primary cancer and also for staging. Management of this rare entity is challenging because of a lack of specific guidelines, and treatment, therefore, is similar to that of breast cancer.Treatment should consist of an individualized combination of surgery, radiotherapy, chemotherapy, and antiestrogen hormonal therapy.
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Affiliation(s)
- Aneesha Ananthula
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Blake Lockwood
- Department of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock
| | - John Savage
- Department of Gynecologic Oncology, University of Arkansas for Medical Sciences, Little Rock
| | - Sharp Malak
- Department of Radiology and Epidemiology, University of Arkansas for Medical Sciences, Little Rock
| | - Chien Chen
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
| | - Issam Makhoul
- Department of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock
| | - Angela Pennisi
- Department of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock
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7
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Matak L, Dukić B, Tupek T, Lisica-Šikić N, Mikuš M. Primary ectopic lobular breast cancer of the vulva: case report and review of literature. J OBSTET GYNAECOL 2019; 40:727-730. [PMID: 31352845 DOI: 10.1080/01443615.2019.1623182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Luka Matak
- Department of Gynecology and Obstetrics, Zadar General Hospital, Zadar, Croatia
| | - Branko Dukić
- Department of Gynecology and Obstetrics, Zadar General Hospital, Zadar, Croatia
| | - Tvrtko Tupek
- Department of Gynecology and Obstetrics, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | | | - Mislav Mikuš
- Department of Gynecology and Obstetrics, University Hospital Centre Zagreb, Zagreb, Croatia
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8
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Al-Mansouri L, Poursoltan P, Simons M, Muljono A, Boyages J. Primary breast cancer of the vulva: A case report and literature review. J Obstet Gynaecol Res 2018; 44:2190-2194. [PMID: 30125424 DOI: 10.1111/jog.13778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/07/2018] [Indexed: 11/29/2022]
Abstract
An elderly lady presented with a 2-year history of intermittent vaginal bleeding and later the development of a vulvovaginal mass. A core biopsy histology specimen from the mass and the left inguinal lymph node was suggestive of metastatic adenocarcinoma of breast origin. No breast lesion was detected on mammography, and axillary nodes were negative. The histopathologic features and the expression of GATA3, cytokeratin (CK)7, mammaglobin staining and estrogen and progesterone receptors led to a diagnosis of breast cancer originating from the ectopic mammary tissue in the vulva. Given the rarity of these lesions, and the lack of standard treatment guidelines, the management of the patient was extrapolated from the established breast cancer treatment guidelines. Radiotherapy and chemotherapy followed by hormone therapy with aromatase inhibitor were administered to this patient in the metastatic setting with good palliation.
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Affiliation(s)
- Loma Al-Mansouri
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Pirooz Poursoltan
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mary Simons
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Anita Muljono
- Histopathologist/Cytopathologist, Douglass Hanly Moir Pathology, Macquarie, New South Wales, Australia
| | - John Boyages
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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9
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Abstract
RATIONALE Ectopic mammary gland tissues occur in about 2% to 6% of women in general population. Vulva is considered a rare site for the ectopic breast tissue. PATIENT CONCERNS We report a rare case of a 27 year-old woman, para 2 and presenting as a vulvar mass in the postpartum period. DIAGNOSES Ectopic mammary tissue in vulva. INTERVENTIONS The mass was removed by wide local excision. Histopathological assessment revealed features of ectopic mammary tissue CONCLUSION:: The vulvar region is one of the reported sites for ectopic breast tissue in the body. The presence of a rapidly enlarging, well-encapsulated mass in the vulvar region associated with recent delivery or lactation is suggestive of ectopic breast tissue. LESSONS It is important for clinicians to get a good history and consider ectopic breast tissue on vulva in postpartum women and confirm diagnosis via biopsy with histopathological examination.
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10
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Lopes A, St Louis J, Balancin ML, Nogueira-Rodrigues A, Silva LCFF, Paulino E, Sá BS, Bukowski A, Barbosa EM, Costa RLR, Goss PE. A Rare Presentation of Primary Breast Carcinoma in the Vulva: A Case Report and Literature Review. Clin Breast Cancer 2017; 18:e291-e294. [PMID: 28709748 DOI: 10.1016/j.clbc.2017.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/30/2017] [Accepted: 06/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Andre Lopes
- Gynecology Department, Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | - Jessica St Louis
- The Global Cancer Institute, Boston, MA; MGH-Avon Global Breast Cancer Program, Boston, MA
| | | | - Angelica Nogueira-Rodrigues
- The Global Cancer Institute, Boston, MA; MGH-Avon Global Breast Cancer Program, Boston, MA; Federal University of Minas Gerais, Belo Horizonte, Brazil; Brazilian Group of Gynecologic Oncology, EVA, Belo Horizonte, Brazil
| | - Luana C F F Silva
- Medical Oncology Department, Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | - Eduardo Paulino
- The Global Cancer Institute, Boston, MA; MGH-Avon Global Breast Cancer Program, Boston, MA; Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Bianca Silveira Sá
- Mastology Department, Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | - Alexandra Bukowski
- The Global Cancer Institute, Boston, MA; MGH-Avon Global Breast Cancer Program, Boston, MA
| | | | | | - Paul E Goss
- The Global Cancer Institute, Boston, MA; MGH-Avon Global Breast Cancer Program, Boston, MA; Harvard Medical School, Boston, MA.
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11
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Ishigaki T, Toriumi Y, Nosaka R, Kudou R, Imawari Y, Kamio M, Nogi H, Shioya H, Takeyama H. Primary ectopic breast cancer of the vulva, treated with local excision of the vulva and sentinel lymph node biopsy: a case report. Surg Case Rep 2017; 3:69. [PMID: 28510222 PMCID: PMC5433958 DOI: 10.1186/s40792-017-0343-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/05/2017] [Indexed: 02/07/2023] Open
Abstract
Primary breast cancer fairly infrequently occurs in ectopic breast tissue, and primary ectopic breast cancer of the vulva is particularly rare. Only 26 cases have been published in the English-language literature, and there has been no report of primary breast carcinoma of the vulva in Japan. We report a rare case of primary ectopic breast cancer of the vulva that was treated with local excision of the vulva and sentinel lymph node biopsy (SLNB). The patient was a 72-year-old woman who had noticed a right vulvar tumor 10 years earlier. The tumor was excised by the Department of Plastic Surgery of our hospital. The histology of the vulvar tumor revealed an invasive ductal carcinoma of the breast, and immunohistochemical staining of the vulvar specimen showed the tumor cells to be 100% estrogen-receptor-positive and 100% progesterone-receptor-positive. All margins of resection were positive for neoplastic involvement. An additional local excision of the vulva and right inguinal SLNB were performed in our department. The intraoperative frozen section was negative for metastasis, and lymph node dissection was not performed. The final pathology was negative for residual disease, and a partially normal ductal component was present. Adjuvant hormonal therapy with an aromatase inhibitor was indicated post-operatively. The patient was asymptomatic and free of detectable disease at a 6-month follow-up. Due to the rarity of this diagnosis, there are no established guidelines for treatment. Although cases in which SLNB was performed are rare, we consider SLNB to be an effective alternative to inguinal node dissection for ectopic primary breast cancer of the vulva.
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Affiliation(s)
- Takayuki Ishigaki
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Yasuo Toriumi
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ryouko Nosaka
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Rei Kudou
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshimi Imawari
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Makiko Kamio
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroko Nogi
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hisashi Shioya
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroshi Takeyama
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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12
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Kredentser AM, Kredentser DC. Adenocarcinoma of the Vulva Arising in Ectopic Breast Tissue: A Case Series and Literature Review. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Collision of Ductal Carcinoma In Situ of Anogenital Mammary-like Glands and Vulvar Sarcomatoid Squamous Cell Carcinoma. Int J Gynecol Pathol 2016; 34:487-94. [PMID: 26107561 DOI: 10.1097/pgp.0000000000000184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A spectrum of invasive adenocarcinomas presumably arising from the anogenital mammary-like glands of the vulva has been reported. Even rarer are the cases of pure ductal carcinoma in situ that originated from these unique glandular structures. Herein, we report an 81-yr-old woman presented with an invasive well-differentiated squamous cell carcinoma of the vulva. Unexpectedly, the underlying dermis demonstrated a cystically dilated structure that displayed a layer of malignant squamous cells in the periphery, and a second centrally located population of neoplastic cells exhibiting glandular differentiation. In addition, a spindle and pleomorphic malignant cell population consistent with a sarcomatoid carcinoma was identified around the cystic structure. Scattered benign anogenital mammary-like glands were present in the adjacent dermis. The histologic and immunohistochemical findings were consistent with those of vulvar squamous cell carcinoma that has undergone sarcomatoid transformation after spreading in a pagetoid fashion into an underlying focus of ductal carcinoma in situ of anogenital mammary-like gland origin.
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14
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Breastlike vulvar carcinoma. ACTA ACUST UNITED AC 2016; 44:74-5. [PMID: 26725883 DOI: 10.1016/j.gyobfe.2015.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/20/2015] [Indexed: 11/20/2022]
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15
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Cripe J, Eskander R, Tewari K. Sentinel lymph node mapping of a breast cancer of the vulva: Case report and literature review. World J Clin Oncol 2015; 6:16-21. [PMID: 25866706 PMCID: PMC4390890 DOI: 10.5306/wjco.v6.i2.16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 01/29/2015] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
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.
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16
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Villada G, Farooq U, Yu W, Diaz JP, Milikowski C. Extramammary Paget Disease of the Vulva With Underlying Mammary-Like Lobular Carcinoma. Am J Dermatopathol 2015; 37:295-8. [DOI: 10.1097/dad.0000000000000065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Steshenko O, Chandrasekaran N, Lawton F. Syringocysadenoma papilliferum of the vulva: a rarity in gynaecology. BMJ Case Rep 2014; 2014:bcr-2014-203902. [PMID: 24872485 DOI: 10.1136/bcr-2014-203902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A case of syringocystadenoma papilliferum of the vulva in a 36-year-old woman is reported .The patient presented with a single cystic lesion on the left labia minora of 8 years duration with a recent increase in size and redness around the lesion. Examination revealed a polypoid cystic lesion with no regional lymphadenopathy. An excision biopsy was performed under general anaesthesia and the specimen was subjected to histological examination. Histopathology revealed closely excised syringocystadenoma papilliferum. On follow-up, the patient was asymptomatic and the wound had healed well.
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Affiliation(s)
- Oleksandr Steshenko
- Department of Obstetrics and Gynaecology, King's College Hospital, London, UK
| | | | - Frank Lawton
- Department of Obstetrics and Gynaecology, King's College Hospital, London, UK
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18
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Wysokinska EM, Keeney G. Breast cancer occurring in the chest wall: rare presentation of ectopic milk line breast cancer. J Clin Oncol 2014; 32:e35-6. [PMID: 24449239 DOI: 10.1200/jco.2012.47.8958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Vulvar fibroadenoma with lactational changes in ectopic breast tissue. Case Rep Obstet Gynecol 2013; 2013:924902. [PMID: 24222874 PMCID: PMC3810074 DOI: 10.1155/2013/924902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/31/2013] [Indexed: 11/29/2022] Open
Abstract
Ectopic breast tissue represents any type of breast tissue found outside its normal location in the pectoral region. The second most common location for ectopic breast tissue after axilla is the vulvar region. We present a case of a healthy 20-year-old female, G1P1, who presented to the Emergency Department with a sudden increase in size of a painful mass located in her vulva, which started 4 days after a spontaneous vaginal delivery and 3 days after initiation of breast-feeding of her newborn. She reported a stable, smaller, painless mass in the same location for almost 2 years prior to this episode. After surgical excision, a fibroadenoma with lactation changes within ectopic breast tissue was confirmed.
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20
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Butler B, Leath CA, Barnett JC. Primary invasive breast carcinoma arising in mammary-like glands of the vulva managed with excision and sentinel lymph node biopsy. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 7:7-9. [PMID: 24624320 PMCID: PMC3895283 DOI: 10.1016/j.gynor.2013.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/04/2013] [Indexed: 11/27/2022]
Abstract
Primary invasive breast carcinoma can be found arising from within mammary-like glands in the vulva. There is no standard management strategy for this rare disease; treatment recommendations should be similar to that for primary breast carcinoma. The use of sentinel lymph node biopsy may offer another management option for this disease.
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Affiliation(s)
- Brandy Butler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, San Antonio Military Medical Center, Ft. Sam Houston, TX, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, San Antonio Military Medical Center, Ft. Sam Houston, TX, USA
| | - Jason C Barnett
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, San Antonio Military Medical Center, Ft. Sam Houston, TX, USA
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21
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Primary breast adenocarcinoma in ectopic breast tissue in the vulva. Case Rep Obstet Gynecol 2013; 2013:721696. [PMID: 24066246 PMCID: PMC3770028 DOI: 10.1155/2013/721696] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 07/28/2013] [Indexed: 12/16/2022] Open
Abstract
Introduction. Accessory breast tissue is a rare finding in the general population with an incidence of 1-2%. An even rarer occurrence is accessory breast tissue afflicted with breast carcinoma. We present a brief report discussing diagnosis and management of a patient who presented with primary breast adenocarcinoma in vulval supranumerary tissue. Brief Report. A 60-year-old Caucasian female presented with a lesion in her left vulva that she first identified during adolescence. The lesion began to grow and ulcerate prompting her to receive treatment. Biopsy was inconclusive, and metastatic workup was negative, so her lesion was treated as an isolated breast lump and removed via wide local excision. Conclusion. Primary breast adenocarcinoma of the vulva is exceedingly rare. A paucity of the literature on this topic unfortunately means that strong evidence does not exist detailing the best management of this patient cohort. However, given that histological data confirms these cancers are virtually the same as breast cancers, it logically follows that the best treatment practices for breast cancer may be applied to treat these patients presenting with primary vulva cancers of ectopic breast tissue.
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Lamb A, Darus CJ, Skripenova S, Weisberg T, Miesfeldt S. Association of primary breast cancer of the vulva with hereditary breast and ovarian cancer. J Clin Oncol 2013; 31:e231-2. [PMID: 23530107 DOI: 10.1200/jco.2012.45.5972] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Amanda Lamb
- Cancer Risk and Prevention Program, Maine Medical Center Cancer Institute, Maine Medical Center, Scarborough, ME 04107, USA
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Hidradenoma papilliferum with mixed histopathologic features of syringocystadenoma papilliferum and anogenital mammary-like glands: report of a case and review of the literature. Am J Dermatopathol 2012; 34:104-9. [PMID: 22262361 DOI: 10.1097/dad.0b013e31820e63e8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hidradenoma papilliferum of the anogenital region was previously believed to originate from apocrine glands but has recently been accepted as originating from anogenital mammary-like glands. We describe a case of hidradenoma papilliferum with mixed features of syringocystadenoma papilliferum and mammary-like glands from the left labia majora of a 25-year-old woman. Histopathologically, the lesion showed an epithelial lining with apocrine secretion, and like syringocystadenoma papilliferum, the lesion extended from the epithelium as invaginations into the dermis. Adjacent to this lesion were ductal and glandular structures resembling normal mammary tissue. This review of the literature highlights the heterogeneity and complexity of lesions arising from anogenital mammary-like glands, and this case serves as further documentation of the association between anogenital mammary-like glands and hidradenoma papilliferum.
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Naseer MA, Mohammed SS, George SM, Das Majumdar SK. Primary ectopic breast cancer mimicking as vulval malignancy. J OBSTET GYNAECOL 2012; 31:553-4. [PMID: 21823871 DOI: 10.3109/01443615.2011.587054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- M A Naseer
- Department of Oncology and Hematology, Salmaniya Medical Complex, Manama, Bahrain.
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26
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Abstract
Long considered to be ectopic breast tissue representing the caudal remnants of the milk ridges, anogenital mammary-like glands are nowadays thought to represent a normal constituent of the anogenital area. Lesions involving these glands, benign or malignant, epithelial or stromal manifest a striking similarity to their mammary counterparts. This review addresses the recent literature on lesions of anogenital mammary-like glands and our personal experience with various lesions related to these structures. Discussed are the normal anatomy and histology of these glands as well as the clinical presentation, histopathological and immunohistochemical features, molecular biological aspects, and differential diagnosis of various lesions involving anogenital mammary-like glands, including lactating adenoma, hidradenoma papilliferum, hidradenocarcinoma papilliferum, fibroadenomas, phyllodes tumor, pseudoangiomatous stromal hyperplasia, extramammary Paget disease, and other carcinomas. In addition, "nonspecific" epithelial or stromal changes some of which can be likened to similar changes occurring in a range of benign breast disease, including sclerosing adenosis, columnar cell lesions, ductal lesions and various metaplastic changes affecting epithelium and myoepithelium are discussed. Although lesions of anogenital mammary-like glands are often discussed in many dermatopathology textbooks in the context of cutaneous adnexal neoplasms we advocate that the best approach to the diagnosis of these lesions is to relate them to analogous well recognized lesions occurring in the breast, that is, through the eyes of a breast pathologist. This will enable their recognition, precise classification and should introduce greater uniformity in how they are reported in the literature so that more meaningful clinicopathological comparisons and correlations may be made.
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27
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Fibroadenoma of the axillary accessory breast: diagnostic value of dynamic magnetic resonance imaging. Jpn J Radiol 2010; 28:613-7. [PMID: 20972862 DOI: 10.1007/s11604-010-0466-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 05/20/2010] [Indexed: 10/18/2022]
Abstract
Accessory breast is synonymous with polymastia or supernumerary breast tissue. An accessory breast without a nipple or areola is rare. We report a case of fibroadenoma of an accessory breast with no nipple or areola in a 41-year-old woman who presented with a right axillary mass associated with five small nodules in the normally situated breast. Magnetic resonance imaging (MRI) showed the accessory breast surrounding the tumor. We ignored the presence of the component surrounding the mass and made a preoperative diagnosis of an axillary mass of possible metastases from multiple breast cancers or breast cancer of unknown origin associated with multiple breast fibroadenomas. From a retrospective view, based on the histological results, MRI and dynamic MRI demonstrated a tiny component of breast-like tissue surrounding the axillary mass and an enhancement pattern typical of fibroadenoma for the axillary mass. For the later diagnosis of the axillary mass, the interpretation of whether the component of breast tissue surrounding the axillary mass was present is crucial. If the component exists, a tumor that originated from the accessory breast should be foremost in the differential diagnosis. Dynamic MRI appears to contribute to the diagnosis of fibroadenoma of an accessory breast before biopsy or surgical resection.
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28
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Abstract
Breast neoplasm may develop in ectopically located glandular tissue. This paper presents an interesting and rare case of a 50-year-old female who despite regular mammography screening examination developed an invasive accessory breast cancer. Clinical examination revealed a 2 cm - tumour localized 4 cm below the left inframammary fold. The lesion was immobile, the skin and the atrophic nipple were retracted, the tumour infiltrated the thoracic wall. Oligobiopsy and additional examinations showed an invasive stage IIIB ductal breast cancer (Bloom II, G-2). The receptor status was: ER(+), PGR(+), HER2(-). The increased level of cancer antigen 15.3 was found. The patient was submitted to pre-operative chemotherapy. She also underwent surgery and subsequently post-operative chemotherapy and radiotherapy. On the basis of the presented case, it could be concluded that the accessory mammary glands are out of the image of screening breast examinations. Accessory breast cancer is usually diagnosed by clinical examination and ultrasonography. Preventive resection of accessory breast in women at high risk of developing breast cancer can be considered as the treatment of choice in most patients.
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29
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Fibroadenoma en mama axilar supernumeraria; reporte de un caso. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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30
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Fibroadenoma and Phyllodes Tumors of Anogenital Mammary-like Glands: A Series of 13 Neoplasms in 12 Cases, Including Mammary-type Juvenile Fibroadenoma, Fibroadenoma With Lactation Changes, and Neurofibromatosis-associated Pseudoangiomatous Stromal Hyperplasia With Multinucleated Giant Cells. Am J Surg Pathol 2010; 34:95-103. [DOI: 10.1097/pas.0b013e3181c6e5c5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Hassani H, Demuynck F, Auquier F, Merviel P, Le Blanche A. Cancer du sein sur tissu mammaire ectopique : à propos d’un cas. ACTA ACUST UNITED AC 2009; 90:1089-91. [DOI: 10.1016/s0221-0363(09)73251-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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32
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Scurry J, van der Putte SC, Pyman J, Chetty N, Szabo R. Mammary-like gland adenoma of the vulva: review of 46 cases. Pathology 2009; 41:372-8. [DOI: 10.1080/00313020902884493] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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33
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Vulvar apocrine adenocarcinoma: A case with nodal metastasis and intranodal mucinous differentiation. Pathol Res Pract 2009; 205:131-5. [DOI: 10.1016/j.prp.2008.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 06/27/2008] [Accepted: 07/10/2008] [Indexed: 11/20/2022]
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34
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Aksoy HM, Aksoy B, Portakal S, Ozdemir A. An uncommon location for accessory breast tissue: inner thigh. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-008-0286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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35
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Tseung J, Russell P. ‘Breast-like’ lesions in the vulva: histology, origin and significance. Pathology 2008; 40:321-6. [DOI: 10.1080/00313020701813628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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36
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Ghosn SH, Khatri KA, Bhawan J. Bilateral aberrant axillary breast tissue mimicking lipomas: report of a case and review of the literature. J Cutan Pathol 2008; 34 Suppl 1:9-13. [PMID: 17997730 DOI: 10.1111/j.1600-0560.2006.00713.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 31 year old Indian woman presented with bilateral axillary masses that became noticeable with the onset of puberty. The masses exhibited similar consistency to the adjacent normal breast tissue but lacked an associated nipple complex. The clinical impression was lipoma; however, mammography, ultrasonography and skin biopsy revealed ectopic breast tissue. These findings were consistent with the diagnosis of aberrant breast tissue. A subset of ectopic mammary tissue, aberrant breast tissue may constitute a diagnostic challenge and is often misdiagnosed as lipoma, hidradenitis, follicular cyst, or lymphadenopathy. In addition, some studies have suggested that aberrant breast tissue may be at higher risk of malignant degeneration. Therefore, it's important that physicians be familiar with this condition as this may contribute to the early detection of ectopic breast cancer.
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Affiliation(s)
- Samer H Ghosn
- Department of Dermatology, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon.
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37
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Ahmed S, Campbell RM, Li JH, Wang LJ, Robinson-Bostom L. Adenoma of anogenital mammary-like glands. J Am Acad Dermatol 2007; 57:896-8. [PMID: 17845825 DOI: 10.1016/j.jaad.2006.04.086] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 02/17/2006] [Accepted: 04/04/2006] [Indexed: 11/15/2022]
Abstract
Adenomas in the anogenital region are uncommon. There has been debate about the origin, including ectopic breast tissue, cutaneous apocrine gland, and most recently anogenital mammary-like gland. An anogenital mass in a 36-year-old woman was excised, and histopathologic examination and immunostaining were performed. Microscopic tissue sections showed a morphologic pattern similar to that of a mammary fibroadenoma, and immunostaining demonstrated the presence of estrogen receptors and progesterone receptors. The possibility of adenomas of anogenital mammary-like glands should be considered when evaluating patients with a mass in this area with confirmation by tissue biopsy or aspiration cytology.
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Affiliation(s)
- Sartaj Ahmed
- Department of Medicine, Rhode Island Hospital and Brown Medical School, Providence, Rhode Island 02903, USA
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38
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North J, Perez D, Fentiman G, Sykes P, Dempster A, Pearse M. Primary breast cancer of the vulva: case report and literature review. Aust N Z J Obstet Gynaecol 2007; 47:77-9. [PMID: 17261107 DOI: 10.1111/j.1479-828x.2006.00685.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- John North
- Oncology Department, Otago District Health Board, Dunedin, New Zealand.
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39
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Rubio D, Calderay M, Camarasa N, Repolles M. Cáncer de mama ectópico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2007. [DOI: 10.1016/s0210-573x(07)74479-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Martinez-Palones JM, Perez-Benavente A, Diaz-Feijoo B, Gil-Moreno A, Roca I, García-Jimenez A, Aguilar-Martinez I, Xercavins J. Sentinel lymph node identification in a primary ductal carcinoma arising in the vulva. Int J Gynecol Cancer 2007; 17:471-7. [PMID: 17362321 DOI: 10.1111/j.1525-1438.2007.00817.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Primary or metastasic breast-like carcinoma of the vulva is a rare event. Because of the similarity with breast ductal carcinoma, we think that the same principles used for treatment of orthotopic breast cancer can be applied, as well as the use of sentinel lymph node technique, which is widely accepted in the management of early-stage breast cancer. We report a 49-old-year postmenopausal woman who was referred to our institution after small biopsy of a 3.5- × 3-cm right vulvar tumor. Histopathologically, infiltration of the vulvar dermis by a ductal carcinoma of mammary gland type was reported. At operation, the sentinel node technique revealed two sentinel nodes in the right inguinal area. Although these nodes proved negative for malignancy, the patient underwent wide local excision of tumor and complete ipsilateral inguinofemoral lymphadenectomy. The remaining excised nodes were negative. Surgical specimen proved estrogen- and progesterone-positive receptors, the reason for which the patient received tamoxifen adjuvant therapy. This report represents the first case in the world literature of primary breast carcinoma arising in the vulva in which sentinel lymph node identification has been possible. Because of the rarity of this condition, the pathologic similarity of this tumor along with currently accepted guidelines for the management of breast cancer supports the possibility of local excision and sentinel lymph node identification as a possible alternative to inguinofemoral lymphadenectomy
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Affiliation(s)
- J M Martinez-Palones
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
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41
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Lopes G, DeCesare T, Ghurani G, Vincek V, Jorda M, Glück S, Silva O. Primary ectopic breast cancer presenting as a vulvar mass. Clin Breast Cancer 2006; 7:278-9. [PMID: 16942646 DOI: 10.3816/cbc.2006.n.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ectopic breast tissue is found along the primitive embryonic milk lines, which extend from the axilla to the groin. Rarely, its occurrence has been described in the vulva. We report a patient who developed primary adenocarcinoma of ectopic breast tissue in such a location and present a review of the pertinent medical literature. The predominant pathology is that of invasive ductal carcinoma; however, other tumor types have also been reported in accessory breast tissue. Its treatment usually entails surgical resection with lymph node dissection. Adjuvant therapy should be guided by the same principles as in orthotopic breast carcinoma.
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Affiliation(s)
- Gilberto Lopes
- Department of Oncology, Johns Hopkins Singapore International Medical Center, Singapore.
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42
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Kazakov DV, Belousova IE, Sima R, Michal M. Mammary Type Tubulolobular Carcinoma of the Anogenital Area: Report of a Case of a Unique Tumor Presumably Originating in Anogenital Mammarylike Glands. Am J Surg Pathol 2006; 30:1193-6. [PMID: 16931966 DOI: 10.1097/01.pas.0000213255.67693.e1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case of an unusual tumor that occurred in the perianal area of a 64-year-old woman. Clinical investigation revealed no tumor elsewhere. The lesion was removed and the patient is alive without signs of metastasis or recurrence 5.5 years after surgery. Histopathologically, the neoplasm was composed of single-cell cords of uniform round to ovoid cells intermixed with round to elongated tubules showing decapitation secretion at the luminal border. The tubules were mainly composed of a single cell layer, but focally multilayered epithelium (without evidence of myoepithelial cell differentiation) was seen as well as discrete cribriform structures and intraluminal bridges. Overall, the cell cord component slightly dominated over the tubular component, and the two were intermixed. A vague targetoid arrangement of the cell cords was seen focally. Immunohistochemically, the tumor cells in both components reacted positively for E-cadherin, 34betaE12, estrogen receptors and progesterone receptor and were negative for HER2/neu (c-erbB-2). There was no evidence of myoepithelial cell differentiation with calponin. We believe that the present case is best classified as mammary type tubulolobular carcinoma and, given the location, the origin in anogenital mammary-like glands most likely.
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Affiliation(s)
- Dmitry V Kazakov
- Sikl's Department of Pathology, Charles University Medical Faculty Hospital, Pilsen, Czech Republic
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43
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Fracchioli S, Puopolo M, De La Longrais IAR, Scozzafava M, Bogliatto F, Arisio R, Micheletti L, Katsaros D. Primary "breast-like" cancer of the vulva: a case report and critical review of the literature. Int J Gynecol Cancer 2006; 16 Suppl 1:423-8. [PMID: 16515638 DOI: 10.1111/j.1525-1438.2006.00364.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Ectopic mammary gland tissue in the vulva is an uncommon clinical or pathologic finding. Such ectopic tissue can be the site of the same physiologic and pathologic processes found in the normal breast. However, the occurrence of adenocarcinoma is very rare, the first case being reported by Greene in 1935. We here report the 16th case of primary "breast-like" cancer arising in the vulva, together with a critical review of the literature, in order to highlight the dilemmas of a clinical approach to this neoplasm. Clear guidelines for diagnosis and therapy are still unavailable. The main diagnostic criteria suggested by the authors of previous reports are discussed together with our own findings. The therapeutic approach to this rare malignancy is also critically reviewed. In our opinion, when diagnosis of breast-like vulvar cancer is finally confirmed, treatment and follow-up should be the same as that would be chosen in a case of orthotopic breast neoplasm.
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Affiliation(s)
- S Fracchioli
- Gynecologic Oncology Unit, S. Anna Hospital, Turin, Italy
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Intra M, Maggioni A, Sonzogni A, DE Cicco C, Machado LS, Sagona A, Talakhadze N. A rare association of synchronous intraductal carcinoma of the breast and invasive carcinoma of ectopic breast tissue of the vulva: case report and literature review. Int J Gynecol Cancer 2006; 16 Suppl 1:428-33. [PMID: 16515639 DOI: 10.1111/j.1525-1438.2006.00237.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Only 17 cases of breast carcinoma arising in vulvar ectopic mammary tissue have been reported. We present a unique case of synchronous pure intraductal carcinoma of the breast (DCIS) and invasive carcinoma of ectopic breast tissue of the vulva. A 53-year-old woman presented with a 2-cm nodule in left labium major of the vulva. A surgical biopsy revealed an invasive carcinoma of ectopic mammary tissue. The mammography showed irregular microcalcifications of the right breast. The patient underwent left hemivulvectomy, bilateral inguinal sentinel lymph node biopsy, and radioguided breast resection (radioguided occult lesion localization) of the microcalcifications. The definitive histology revealed negative inguinal sentinel nodes, no further residual tumor in the vulva, and a high-grade (grade 3) DCIS in the breast. The synchronous occurrence of primary breast carcinoma and ectopic breast tissue carcinoma in the vulva is an extremely rare finding, only once previously being reported and leading to unsolved problems of differential diagnosis. The presence of a pure DCIS of the breast makes this case really unique, definitively confirming the independent primary origin of both mammary tumors. The inguinal sentinel node biopsy avoided a bilateral inguinal dissection.
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Affiliation(s)
- M Intra
- Division of Breast Surgery, University of Milan School of Medicine, Milano, Italy.
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45
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Abstract
Mammary-like glands are a poorly recognized structure of normal vulvar skin. Adenocarcinomas arising from these glands are rare and represent a distinct clinicopathologic entity that must be distinguished from metastatic tumors. We reviewed 19 cases reported in the literature and describe a 51-year-old patient with a long-standing nodule on her right interlabial sulcus. Excisional biopsy and Mohs micrographic surgery demonstrated an infiltrating adenocarcinoma of the mammary-like glands involving the dermis and subcutis. On review of all 20 cases, the mean age at diagnosis was 59.6 years, the labia majora were involved in 13 cases (65%), and the mean lesional size was 2.5 cm. The tumor's histologic patterns varied greatly, although the histomorphologic similarity among this neoplasm, sweat gland carcinomas, and invasive extramammary Paget disease suggested a morphologic spectrum among these tumors. Criteria for establishing the diagnosis of adenocarcinoma of mammary-like glands include identifying transition zones between normal mammary-like glands and adenocarcinomatous areas. This tumor is best categorized as a locally aggressive neoplasm with a low risk for widespread metastasis. Use of aggressive surgical therapeutic regimens, particularly in the case of tumors localized to the skin, must be reassessed, especially given the likelihood of long-term morbidity with such regimens. In our patient, successful Mohs micrographic surgery suggests that alternate management may be adopted for tumors localized to the skin, especially in elderly patients.
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Affiliation(s)
- Jared J Abbott
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
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46
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Abstract
Anogenital mammary-like glands, although known to exist (as ectopic breast tissue) as early as 1872, have only recently been thoroughly studied and suggested to be the possible origin for various neoplastic (benign and malignant) and reactive conditions that show a striking homology with lesions in the breast. Reported herein is an unusual benign lesion involving anogenital mammary-like glands in the perineal area of a 41-year-old woman. The lesion is unique in that it does not fully fit into any of the previously recognized conditions affecting anogenital mammary-like glands nor has it an apparent well-defined mammary counterpart. Microscopically, at first glance the lesion appeared as a cluster of extended anogenital mammary-like glands of variable complexity and a lobular architecture, which probably resulted from a compact proliferation of closely situated ducts with small, round lumens (when cut transversally). When cut longitudinally, some of these tiny ducts appeared to bud from larger ductal structures, resembling so-called satellitosis in the breast and this gave a fibroadenomatous appearance to the areas. In addition, there were adenosis-like areas. This lesion extends the spectrum of changes seen in anogenital mammary-like glands.
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Affiliation(s)
- Dmitry V Kazakov
- Sikl's Department of Pathology, Charles University Medical Faculty Hospital, Pilsen, Czech Republic.
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47
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Avilés Izquierdo JA, Martínez Sánchez D, Suárez Fernandez R, Lázaro Ochaita P, Longo-Imedio MI. Pigmented Axillary Nodule: Carcinoma of an Ectopic Axillary Breast. Dermatol Surg 2006; 31:237-9. [PMID: 15762222 DOI: 10.1111/j.1524-4725.2005.31049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ectopic mammary tissue appears in humans owing to an incomplete embryologic regression of the mammary ridges. The same pathology that affects normally positioned breasts, including carcinoma, can occur in ectopic mammary tissue. OBJECTIVE The objective was to present the case of a 43-year-old woman who developed a ductal mammary carcinoma of ectopic breast tissue. METHODS We describe the patient's history, the histologic diagnosis, and the therapy carried out. We also discuss the clinical differential diagnosis and current management options. RESULTS The patient developed a ductal mammary carcinoma in the axilla, which is the most common site for the occurrence of carcinoma of ectopic breast tissue. She has been sucessfully treated with surgery, lymphadenectomy, radiotherapy, and chemotherapy. Accessory mammary tissue is a relatively frequent incidental finding, whereas carcinoma of ectopic tissue is very rare. CONCLUSIONS Carcinoma occurring in ectopic breast tissue remains rare, but this diagnosis must be suspected when confronted with any axillary nodule. The prognosis is similar to carcinoma of normal breast in the same tumor, node, metastasis stage, although it has a higher rate of lymph node involvement. There is no consensus on the advisability of excising ectopic mammary tissue.
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48
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Kazakov DV, Bisceglia M, Mukensnabl P, Michal M. Pseudoangiomatous Stromal Hyperplasia in Lesions Involving Anogenital Mammary-Like Glands. Am J Surg Pathol 2005; 29:1243-6. [PMID: 16096415 DOI: 10.1097/01.pas.0000164346.61765.9d] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pseudoangiomatous stromal hyperplasia (PASH), first reported in 1986, is nowadays a well-recognized change in the breast. We present three cases of lesions involving anogenital mammary-like glands demonstrating this feature. All patients were females (ages, 42, 43, and 53 years). Each presented with a solitary, 1.5- to 2-cm asymptomatic nodule. Locations included the perianal area, perineum, and labium majus. Histopathologically, one lesion was classified as low-grade phyllodes tumor, another as fibroadenoma, and in the remaining case PASH was found in the background of mild hyperplasia of anogenital mammary-like glands and substantial lipomatous metaplasia. In all lesions, PASH had an identical appearance to that in the breast, that is open, slit-like, often anastomosing channels devoid of erythrocytes and lined by discontinuous, often attenuated, inconspicuous cells without atypia or mitotic activity set in a hyalinized collagenous stroma. Quantitatively, PASH ranged in the above cases, forming a relatively small focus in the fibroadenoma and being quite extensive in the remaining two cases. In the phyllodes tumor, PASH areas exhibited focal hypercellularity and presence of myoid cells. In none of the cases were there cells with intranuclear inclusions or multinucleated cells. The lesions were surgically excised. Two patients with follow-up were disease-free at one and three years after the operation. As to our knowledge, PASH has not been previously described in the anogenital area, this feature seems to have been either overlooked or is genuinely rare in this location. It may occur in a preexisting lesion of anogenital mammary-like glands or may apparently by itself produce a clinically detectable lesion. The clinicopathologic features of PASH in the anogenital area seem to be identical to those in the breast.
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Affiliation(s)
- Dmitry V Kazakov
- Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic.
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Tanaka H, Umekawa T, Nagao K, Ishihara A, Toyoda N. Adenocarcinoma of mammary-like glands in the vulva successfully treated by weekly paclitaxel. Int J Gynecol Cancer 2005; 15:568-71. [PMID: 15882189 DOI: 10.1111/j.1525-1438.2005.15328.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
An 87-year-old was referred for gynecologic evaluation of a lesion involving the left labia majus noted 3 years earlier. Fine-needle aspiration cytology revealed clusters with an acinous structure or glandular formation. The tumor appeared as cell clusters with linear arrangements. Histologic examination showed the same morphologic findings as scirrhus type of primary breast carcinoma. Examinations of the breasts and axillary lymph nodes were normal. This disease was diagnosed as an adenocarcinoma arising in mammary-like glands of the vulva. Bone scan showed multiple foci in the sternum, costa, and vertebrae, consistent with metastatic disease. We administered five courses of weekly paclitaxel chemotherapy, which achieved a partial response. There were no severe adverse effects. In our case, the fine-needle aspiration cytology was a rapid and minimally invasive method of diagnosis, and the findings were extremely similar to those of the scirrhus type of primary breast carcinoma. Rapid and accurate diagnosis made with this technique might contribute to a good prognosis in the early-staged cases. Weekly paclitaxel chemotherapy may be one of the safe and effective treatments for this disease with distant metastases, even in extremely aged patients (over 80 years).
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Affiliation(s)
- H Tanaka
- Department of Obstetrics and Gynecology, Mie Prefectural Shima Hospital, Shima, Japan.
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Khunamornpong S, Siriaunkgul S, Suprasert P, Chitapanarux I. Yolk sac tumor of the vulva: a case report with long-term disease-free survival. Gynecol Oncol 2005; 97:238-42. [PMID: 15790466 DOI: 10.1016/j.ygyno.2004.12.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Yolk sac tumor (YST) of the vulva is extremely rare. Seven cases of vulvar YST have been reported to the literature. Due to the rarity of tumors, the appropriate choice of treatment may remain unclear. CASE A 30-year-old woman presented with a 3.5-cm right labial mass. Excisional biopsy showed YST with predominant solid pattern. Three weeks after excision, right inguinal lymph node biopsy revealed metastatic tumor. The serum alpha-fetoprotein (AFP) was not elevated. Cisplatin-based chemotherapy was administered, followed by pelvic and groin irradiation. The patient was free of disease 90 months after the diagnosis. CONCLUSION Local excision of tumor with adjuvant cisplatin-based chemotherapy can be justified for vulvar YST. Inguinal lymphadenectomy is recommended because metastasis may occur early. Adjuvant radiation therapy may help to control the disease. Tumor size of 5 cm or less may be a favorable prognostic factor. Serum AFP level may not be a sensitive marker for follow-up of vulvar YST.
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Affiliation(s)
- Surapan Khunamornpong
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
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