Invasive lobular carcinoma arising in accessory breast tissue

  • Catriona Devine1,

    Affiliated with

    • Carol-Ann Courtney1,

      Affiliated with

      • Rahul Deb2 and

        Affiliated with

        • Amit Agrawal1, 4, 3Email author

          Affiliated with

          World Journal of Surgical Oncology201311:47

          DOI: 10.1186/1477-7819-11-47

          Received: 13 September 2012

          Accepted: 15 February 2013

          Published: 26 February 2013

          Abstract

          Background

          Lobular carcinoma in accessory breast tissue is a rare occurrence. We present such a case in a 61-year-old woman.

          Case presentation

          A skin nodule in the axillary skin on excision biopsy revealed invasive lobular carcinoma.

          Conclusions

          Carcinoma in accessory breast tissue is uncommon especially invasive lobular type. A high index of suspicion may avoid late diagnosis.

          Background

          Accessory breast tissue is seen in 2% to 6% of the population[1] with carcinoma in this accessory tissue reported rarely. The most common morphological variant is invasive ductal carcinoma. We present a rare case of invasive lobular carcinoma in the accessory breast tissue.

          Case presentation

          A 61-year-old postmenopausal woman with a 14-month history of 3 × 2.5 cm, indurated rubbery nodule of the left axilla was referred by the dermatologist to the plastic surgeons for an excision biopsy with 1 cm margin for a possible soft tissue tumor.

          Histology revealed an unexpected primary breast cancer: grade 2 invasive lobular carcinoma measuring 2.2 cm on a background of lobular carcinoma in situ along with normal breast tissue (Figures 1 and2). The patient was then referred to the breast multidisciplinary team (MDT) for further management.
          http://static-content.springer.com/image/art%3A10.1186%2F1477-7819-11-47/MediaObjects/12957_2012_Article_1242_Fig1_HTML.jpg
          Figure 1

          Lobular carcinoma with axillary skin (Magnification ×40).

          http://static-content.springer.com/image/art%3A10.1186%2F1477-7819-11-47/MediaObjects/12957_2012_Article_1242_Fig2_HTML.jpg
          Figure 2

          Lobular carcinoma with dermis (Magnification ×200).

          There was no previous personal or family history of breast cancer. Subsequent mammography and breast magnetic resonance imaging (MRI) were reported as normal. As the margins were involved she underwent re-excision of margins with axillary node sampling. Both the new margins and the nodes were free of disease.

          The patient underwent adjuvant radiotherapy to the breast and was commenced on adjuvant anastrozole for this estrogen receptor positive tumor.

          Conclusions

          The incidence of accessory breast is 2% to 6% of the general population[1]. It is the consequence of partial regression of the primitive milk streak which forms in the human embryo[2, 3]. Accessory breast tissue is seen along the milk line[4] but is most frequent in the axillary region.

          Embryologically being breast tissue, the accessory breast tissue is subject to homeostatic hormonal controls too and thus may become clinically apparent during puberty or pregnancy. Similarly, it is also subject to pathological changes that occur in the normal anatomical site of the breasts. There are numerous reports of masses arising in accessory breast tissue including fibroadenomas and breast cancers[1, 2, 5, 6]. The principal malignancy identified in accessory breast tissue, as with normal breasts, is invasive ductal carcinoma (79%), followed by medullary and lobular carcinomas which are seen in less than 10% of cases[6]. Accessory axillary carcinoma is a rare form of breast cancer. In this case report, the patient had both invasive lobular carcinoma and lobular carcinoma in situ in the accessory axillary tissue, which is an unusual finding.

          This case report presents an invasive carcinoma discovered early with no lymph node involvement. The overall prognosis is similar to carcinoma of normal breast in the same tumor, node, metastasis stage, although given the location within the axillary lymph node basin, the likelihood of metastases is high[7]. It is, therefore, imperative that a lump in the axillary region is triple assessed as in any breast pathology to rule out carcinoma in the accessory axillary tissue to achieve a potentially curable status. It is also important to evaluate for accessory tissue on the contra-lateral side because 13% of the cases are bilateral in normal breast[8].

          The standard UK practice is to perform MRI of the breasts in suspected or diagnosed mammographically occult invasive lobular cancer and, therefore, this imaging modality should be used if there is a high index of suspicion of carcinoma in accessory breast tissue[9]. Adjuvant systemic therapy should be guided by the standard guidelines and practice (such as according to estrogen receptor (ER), human epidermal growth factor receptor-2 (HER2) status, tumor grade, stage, prognostic indices)[6, 10].

          Consent

          Written informed consent was obtained from the patient for publication of this Case report and any accompanying images.

          Declarations

          Authors’ Affiliations

          (1)
          Department of Breast Surgery, Royal Derby Hospital
          (2)
          Department of Pathology, Royal Derby Hospital
          (3)
          Nottingham Breast Institute
          (4)
          Department of Breast Surgery, Graduate Entry Medicine (GEM) School, Royal Derby Hospital, University of Nottingham

          References

          1. Gutermuth J, Audring H, Voit C, Haas N: Primary carcinoma of ectopic axillary breast tissue. J Eur Acad Dermatol: JEADV. 2006, 20: 217-221. 10.1111/j.1468-3083.2005.01362.x.View ArticlePubMed
          2. Evans D, Guyton D: Carcinoma of the axillary breast. J Surg Oncol. 1995, 59: 190-195. 10.1002/jso.2930590311.View ArticlePubMed
          3. Kahraman-Cetintas S, Turan-Ozdemir S, Topal U, Kurt M, Gokgoz S, Saraydaroglu O, Ozkan L: Carcinoma originating from aberrant breast tissue. A case report and review of the literature. Tumori. 2008, 94: 440-443.PubMed
          4. Bland K, Romrell L: Congenital and acquired disturbances of breast development and growth. The Breast: Comprehensive Management of Benign and Malignant Diseases. Edited by: Bland KI, Copeland EIII. 1998, Philadelphia: WB Saunders, 69-86. 2
          5. Alghamdi H, Abdelhadi M: Accessory breasts: when to excise?. Breast J. 2005, 11: 155-157. 10.1111/j.1075-122X.2005.21623.x.View ArticlePubMed
          6. Marshall M, Moynihan J, Frost A: Ectopic breast cancer: case report and literature review. Surg Oncol. 1994, 3: 295-304. 10.1016/0960-7404(94)90032-9.View ArticlePubMed
          7. Giron G, Friedman I, Feldman S: Lobular carcinoma in ectopic axillary breast tissue. Am Surg. 2004, 70: 312-315.PubMed
          8. du Toit R, Locker AP, Ellis IO, Elston CW, Nicholson RI, Blamey RW: Invasive lobular carcinomas of the breast–the prognosis of histopathological subtypes. Br J Cancer. 1989, 60: 605-609. 10.1038/bjc.1989.323.PubMed CentralView ArticlePubMed
          9. Kriege M, Brekelmans C, Boetes C, Besnard PE, Zonderland HM, Obdeijn IM, Manoliu RA, Kok T, Peterse H, Tilanus-Linthorst MM, Muller SH, Meijer S, Oosterwijk JC, Beex LV, Tollenaar RA, de Koning HJ, Rutgers EJ, Klijn JG, Magnetic Resonance Imaging Screening Study Group: Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Eng J Med. 2004, 351: 427-437. 10.1056/NEJMoa031759.View Article
          10. Bakker J, Sataloff D, Haupt H: Breast cancer presenting in aberrant axillary breast tissue. Commun Oncol. 2005, 2: 117-120. 10.1016/S1548-5315(11)70863-4.View Article

          Copyright

          © Devine et al.; licensee BioMed Central Ltd. 2013

          This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

          Advertisement