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Occurrence of primary carcinoma in ectopic breast tissue is rare. We report the case of year-old woman with accessory breast carcinoma in her left absrans. Because an accessory areola or nipple is often missing and awareness of physicians and patients about these unsuspicious masses is lacking, clinical diagnosis of aberxns breast carcinoma is frequently delayed. Primary carcinoma of ectopic breast tissue has been reported only in a small number of cases.
Embryologically, ectopic breast tissue develops as a result of failed resolution of the mammary ridge, an ectodermal thickening that extends from the axilla to the external genitalia and has been found at sites as disparate as the axilla, labium, and the posterior thigh of a male patient [ 24 ].
In mmmae classification of ectopic breast tissue by Copeland and Geschickter [ 5 ], accessory nipple or areolar formation or both, with or without glandular tissue, is termed supernumerary breast, as opposed to aberrant tissue referring to ectopic breast tissue without a nipple or areolar complex.
We named supernumerary breast as accessory breast.
A year-old female patient had noticed a painless aberanss in her left axillary area 1 month earlier. She was born with bilateral accessory nipples in the axilla. During the lactational period, milk was also released from the accessory nipple.
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She reported no previous menstrual irregularity, dysmenorrhea, or menorrhagia. The patient had received no estrogen therapy or oral contraceptive. There was no family history of breast carcinoma. Physical examination showed a non-tender, poorly defined mass measuring 2 cm in diameter and showing irregular margins fig.
Routine hematological, biochemical parameters and tumor markers carcinoembrionic antigen, CEA; cancer antigen, CA were within normal ranges. However, mammwe imaging findings were interpreted as suspicious for accessory breast carcinoma, and ultrasound-guided biopsy was recommended fig. Histological examination of the biopsy revealed invasive ductal carcinoma. The surgical option was a left accessory breast mastectomy with axillary lymph node dissection.
Pathological examination revealed nammae 1. Estrogen and progesterone receptor proteins were positive and focal positive, respectively, and CerbB2 was negative by immunohistochemistry on paraffin sections. The postoperative treatment included chemotherapy cyclophosphamide, methotrexate, 5-fluor-ouracil, 6 cyclesradiotherapy of the axilla, and mammar for 5 years.
Her postoperative course was uneventful. A Film Mammography shows an approximately 2. B Ultrasonography of the left axilla shows an approximately 1. C Breast magnetic resonance examination shows an approximately 1. Mmmae Photomicrograph shows moderately differentiated invasive ductal carcinoma forming glandular structures hematoxilin-eosin stain x B Photomicrograph shows tumor component invading surrounding mammary adipose tissue hematoxilin-eosin stain x Inheritance may be autosomal dominant with incomplete penetrance, but sporadic cases represent the more common situation [ 7 ].
The most common pathology, as with the normal breast, is invasive ductal carcinoma [ 3 ]. There is no difference in diagnosis and symptoms of accessory breast carcinoma compared with carcinoma of the anatomic breast. The most common physical sign is a palpable mass. Edema, tenderness, breast pain, and vague discomfort are less often observed [ abrrans ].
These tumors are diagnosed in the same manner as anatomic breast carcinoma using Mammography and ultrasonography, followed by pathologic diagnosis via fine needle aspiration cytology or gross excision [ 10 ]. Differential diagnosis includes excess axillary fat, lymphadenitis, lymphoma, metastatic carcinoma, and hydradenitis suppurativa [ 13 ].
Some authors have recommended radical mastectomy of the ipsilateral breast if the regional lymph nodes are diagnosed with carcinoma [ 1415 ]. However, Cogwells [ 16 ] has reported that ipsilateral mastectomy does not result in a better prognosis for ectopic breast carcinoma.
Evans and Guyton [ 2 ] have concluded that ipsilateral mastectomy in addition to axillary lymph node dissection was not superior to local excision with node dissection. It has been proposed that the surgical procedure of choice in ectopic breast carcinoma is wide resection of the tumor with surrounding tissue, covering skin, and regional lymph nodes [ 117 ]. Mastectomy is not indicated if clinical examination, mammography, and ultrasonography of the anatomic breast show no signs of disease, and should be performed when differential diagnosis is difficult [ 31518 ].
If mastectomy is not performed, particularly careful follow-up is, of course, necessary to exclude any later manifestation of an occult primary neoplasm in the breast. The principles of postoperative treatment are the same as for anatomic breast carcinoma [ 18 ]. External radiotherapy of the tumor site must be performed because it permits increased local control.
However, radiation of the homolateral anatomic breast is not systematically performed [ 19 ]. Systemic adjuvant therapy is more frequently required because lymph node disease is usually found, and is performed following the same rules as with anatomic breast carcinoma [ 1519 ].
Prognosis of accessory breast carcinoma is equally difficult to establish, primarily due to absent or limited follow-up data as well as small sample size [ 2 ].
Moreover, it is difficult to ammmae a clear histopathological and clinical distinction between accessory and anatomic breast carcinoma [ 15 ]. Some authors have proposed that accessory breast tissue is more prone to malignant change than normal breast parenchyma [ 20 ].
Others report that carcinoma of accessory breast makmae may metastasize to lymph nodes earlier and more frequently than with anatomic breast carcinoma [ 319 ]. However, accessory breast carcinoma can be said to follow the same prognostic indices as anatomic breast carcinoma [ 1 ]. National Center for Biotechnology InformationU. Journal List Breast Care Basel v. Published online Apr Author information Copyright and License information Disclaimer.
Sung Hoo Jung, M. This article has mammwe cited by other articles in PMC. Case Report We report the case of year-old woman with accessory breast carcinoma in her left axilla. Conclusion Because an accessory areola or nipple is often missing and awareness of physicians and patients about these unsuspicious masses is lacking, clinical diagnosis of accessory breast carcinoma is frequently delayed. Accessory breast, Breast Cancer, Axilla.
Introduction Primary carcinoma of ectopic breast tissue has been reported only in a small number of cases. Case Report A year-old female patient had noticed a painless lump in her left axillary area 1 month earlier. Open in a separate window. Conflict of Interest The authors confirm that there was no conflict of interest. Carcinoma of the axillary breast. Primary breast cancer in aberrant breast tissue in the axilla. Accessory breast on the posterior thigh of a man. J Am Acad Dermatol.
Symposium on diagnosis and treatment of premalignant conditions. Surg Clins N Am. Aberana carcinoma of ectopic axillary breast tissue. J Eur Acad Dermatol Venereol.
Accessory Breast Carcinoma
Hanson Abrans, Segovia J. Ectopic breast cancer of the axilla. Mammary carcinoma in ectopic breast tissue. Congenital and acquired disturbances of breast development and growth. Comprehensive Management of Benign and Malignant Diseases.
The management of ectopic breast cancer — case report. Eur J Gynaecol Oncol. Carcinoma of aberrant breast mamae. Metastatic accessory breast carcinoma in a thoracic subcutaneous nodule. J Royal Soc Med. Breast cancer in ectopic breast tissue. Breast carcinoma located in ectopic breast tissue: Supernumerary mammae with special reference to the rhesus monkey.