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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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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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3
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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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4
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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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5
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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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6
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Spectrum of Changes in Anogenital Mammary-like Glands in Primary Extramammary (Anogenital) Paget Disease and Their Possible Role in the Pathogenesis of the Disease. Am J Surg Pathol 2017; 41:1053-1058. [DOI: 10.1097/pas.0000000000000857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Konstantinova AM, Belousova IE, Kacerovska D, Michal M, Shelekhova KV, Kazakov DV. [Anogenital mammary-like glands and related diseases. Part 2. Malignant tumors of the anogenital glands]. Arkh Patol 2017. [PMID: 28631716 DOI: 10.17116/patol201779347-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mammary-like glands are a normal anatomical component of the anogenital region and can give rise to many benign and malignant tumors that morphologically mimic the similar diseases of the breast. The literature review is complemented by a description of 199 cases of malignant tumors of mammary-like glands. The paper presents the clinical and morphological characteristics of various malignant tumors of mammary-like glands, including extramammary Paget's disease, ductal, tubulolobular, adenoid cystic adenocarcinoma, low-grade phyllodes tumor, etc.
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Affiliation(s)
- A M Konstantinova
- Pathology Department, Saint Petersburg Clinical Research and Practical Center for Specialized Care, Saint Petersburg, Russia; Department of Pathology, Medical Faculty, Saint Petersburg State University, Saint Petersburg, Russia; Department of Pathology, Saint Petersburg Sociomedical Institute, Saint Petersburg, Russia
| | - I E Belousova
- Pathology Department, Saint Petersburg Clinical Research and Practical Center for Specialized Care, Saint Petersburg, Russia; Department of Pathology, Saint Petersburg Sociomedical Institute, Saint Petersburg, Russia; Department of Skin and Venereal Diseases, Military Medical Academy, Saint Petersburg, Russia
| | - D Kacerovska
- Department of Pathology, Charles University, Plzen, Czech Republic
| | - M Michal
- Department of Pathology, Charles University, Plzen, Czech Republic
| | - K V Shelekhova
- Pathology Department, Saint Petersburg Clinical Research and Practical Center for Specialized Care, Saint Petersburg, Russia; Department of Pathology, Saint Petersburg Sociomedical Institute, Saint Petersburg, Russia
| | - D V Kazakov
- Department of Pathology, Charles University, Plzen, Czech Republic
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8
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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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9
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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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10
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Syringomatous Structures in Extramammary Paget Disease: A Potential Diagnostic Pitfall. Am J Dermatopathol 2016; 38:653-7. [DOI: 10.1097/dad.0000000000000497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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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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12
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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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13
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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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14
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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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15
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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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16
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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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17
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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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18
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Kazakov DV, Mikyskova I, Kutzner H, Simpson RHW, Hes O, Mukensnabl P, Bouda J, Zamecnik M, Kinkor Z, Michal M. Hidradenoma Papilliferum with Oxyphilic Metaplasia. Am J Dermatopathol 2005; 27:102-10. [PMID: 15798433 DOI: 10.1097/01.dad.0000154400.45465.a7] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reported here are 18 cases of hidradenoma papilliferum with oxyphilic metaplasia. All patients were women ranging in age from 29 to 74 years. Each presented clinically with a small, solitary tumor in the anogenital region. Microscopically, in addition to classic histopathological features, in every case there was oxyphilic metaplasia of the constituent epithelial cells. This finding could be likened to apocrine metaplasia, a term used in breast pathology. Other histopathological findings observed in this series, analogous to benign breast disease, included sclerosing adenosis-like changes, atypical apocrine adenosis-like changes, changes corresponding to usual ductal epithelial hyperplasia, epitheliomatosis with a streaming growth pattern, lamprocyte-like changes, clear cell change of the myoepithelium, foamy histiocyte reaction, and stromal fibrosis. Immunohistochemistry inferred that in the majority of cases oxyphilic metaplasia resulted from more lysosomes, whereas numerous mitochondria were detected in only 3 cases. Using 2 different PCR methods we identified HPV in 4 of 15 cases of hidradenoma with oxyphilic metaplasia. In addition, HPV was detected in 3 of 16 conventional papillary hidradenomas used as a control group. The following HPV types were identified: 16, 31, 33, 53, and 56. The last type was found in 5 cases. More than one HPV type from a single lesion was seen in 5 cases. Our observations are consistent with previous publications noting similarities between tumors of the breast and sweat glands. Oxyphilic metaplasia, areas with solid growth, and changes simulating atypical apocrine adenosis are rare and poorly recognized in hidradenoma papilliferum and may cause diagnostic difficulties; in our cases several submitting pathologists suspected malignancy. A causal role for HPV in hidradenoma papilliferum cannot be confirmed from our results, as the detection rate is too low. The exact role of the HPV in etiology and pathogenesis of this neoplasm has yet to be determined.
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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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19
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Ohira S, Itoh K, Osada K, Oka K, Suzuki A, Osada R, Kobayashi M, Konishi I. Vulvar Paget's disease with underlying adenocarcinoma simulating breast carcinoma: case report and review of the literature. Int J Gynecol Cancer 2004; 14:1012-7. [PMID: 15361217 DOI: 10.1111/j.1048-891x.2004.14544.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We report a case of extramammary Paget's disease with underlying adenocarcinoma simulating breast carcinoma of the vulva. An 82-year-old woman was found to have a 5 x 3-cm bulky tumor located in the left labium major, infiltrating to the clitoris, left labium minor, and left lateral tissue of the vulva. Small biopsy of the vulva showed intraepidermal proliferation of Paget cells. The patient underwent wide local excision of the vulvar tumor and dissection of left inguinal lymph nodes. Histopathological examination of the resected specimens revealed that Paget cells were distributed singly or tended to form small nests in the epidermis, and that association of these cells with the underlying carcinoma invading to the subcutis could be seen. The underlying carcinoma was composed of squamoid solid nests with central necrotic debris, mimicking 'comedocarcinoma' of the breast. In other areas, the tumor cells were present in tubular formations and solid cords reminiscent of invasive ductal carcinoma of the breast. Immunohistochemically, the Paget cells and the underlying carcinoma cells were positive for carcinoembryonic antigen, epithelial membrane antigen, estrogen receptors, and glandular keratins except for CK 20. We speculate that our case is vulvar Paget's disease presenting as a manifestation of underlying breast carcinoma of the vulva, which might have arisen from either the ectopic breast tissue or anogenital mammary-like glands.
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Affiliation(s)
- S Ohira
- Departments of Obstetrics and Gynecology, and Laboratory Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan.
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20
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Abstract
Recently a variant of cutaneous glands has been recognized in the anogenital region that combines the morphologic and immunohistochemical features of eccrine, apocrine, and mammary glands, so-called 'mammary-like glands of the vulva'. Carcinoma arising in mammary-like tissue of the vulva is a rare occurrence. So far, there have been 11 cases of primary, mammary-type invasive carcinoma and one case of in-situ carcinoma reported in the vulva. We describe an unusual case of ductal carcinoma in-situ without invasion arising in mammary-like glands of the vulva. A 57-year old woman presented with a 1-year history of a 1 cm nodule in the right labium majus. Excision showed ductal carcinoma in-situ with cribriform and papillary morphology in an adenosis-like lesion associated with mammary-like glands. No invasion into the stroma was identified. Immunostains were positive for gross cystic disease fluid protein 15 (GCDFP-15) and estrogen and progesterone receptors. An extensive survey including bilateral mammograms was negative. One year postoperatively, the patient shows no evidence of disease. To our knowledge, this represents the second case of DCIS associated with mammary-like glands of the vulva reported in the English literature.
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Affiliation(s)
- C Y Castro
- Department of Pathology (KB 728), University of Alabama at Birmingham, 619 19th Street South, Birmingham, Alabama 35249-7331, USA
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21
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Abstract
The eleventh case of primary infiltrating ductal carcinoma of the vulva is reported with a review of the literature. The infiltrating tumor is associated with an intraductal component as well as noninvolved mammary-like glandular tissue (ectopic breast tissue) and metastases to inguinal lymph nodes. Estrogen receptor and progesterone receptor immunohistochemical staining is negative utilizing the HSCORE method. The treatment regimen is patterned after approach to node-positive breast carcinoma.
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MESH Headings
- Aged
- Breast
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/therapy
- Choristoma/pathology
- Female
- Humans
- Immunohistochemistry
- Lymphatic Metastasis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Vulvar Neoplasms/metabolism
- Vulvar Neoplasms/pathology
- Vulvar Neoplasms/therapy
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Affiliation(s)
- D A Kennedy
- Department of Pathology, University of Wisconsin Hospital and Clinics, Madison, USA
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