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Busbait S, Alkhalifa AM, Aljohani S, Alhaddad H. Occult Invasive Lobular Carcinoma Presenting as an Axillary Skin Metastatic Lesion Underwent Neoadjuvant Endocrine Therapy and Surgical Resection: A Case Report and Review of Literature. BREAST CANCER: TARGETS AND THERAPY 2022; 14:145-152. [PMID: 35669610 PMCID: PMC9166690 DOI: 10.2147/bctt.s366785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022]
Abstract
Introduction Invasive lobular carcinoma (ILC) is the second most common type of breast cancer accounting for 5–15% of all breast cancer cases. It usually presents with nonspecific signs and symptoms. Occult breast cancer presenting as an axillary mass is rare, with prevalence of 0.3–1%, less likely with isolated cutaneous breast metastasis as a first presentation. There are limited data in the literature on patients who underwent endocrine therapy and complete surgical resection. Case Presentation A 54-year-old woman with left axillary skin swelling that had been persisting for 6 years was diagnosed with ILC 18 months ago presenting with an ulcerated axillary skin lesion and was managed with letrozole in another facility as she was estrogen receptor (ER) and progesterone receptor (PR) positive. She received letrozole for 18 months and had a partial response in the form of healing of the ulcer with persistent subcutaneous nodules. Her breast mammogram, ultrasound, and magnetic resonance imaging findings were unremarkable; however, there were few prominent left axillary lymph nodes. A biopsy of the left axillary lymph node was positive for malignancy, consistent with ILC. A skin punch biopsy of the axillary skin lesion showed ILC extending to the dermis with no background breast tissue. The patient underwent left modified radical mastectomy with excision of the left axillary skin lesion. The breast specimen comprised 0.4 mm of ILC as the primary malignancy and nine positive axillary lymph node malignancies. The patient received adjuvant radiotherapy and continued to receive letrozole. There were no signs of complications or recurrence during the follow-up period. Conclusion Ulcerated skin lesions in the axilla should raise concerns regarding breast cancer metastasis. In cases of isolated cutaneous breast metastases, surgical excision can be considered in combination with endocrine therapy.
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Affiliation(s)
- Saleh Busbait
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
- Correspondence: Saleh Busbait, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Al-Khobar, 31441, Saudi Arabia, Tel +966 138966666 Ext 1680, Fax +966 133330108, Email
| | - Abdullah M Alkhalifa
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Shahad Aljohani
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Hiyam Alhaddad
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
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Ouldamer L, Cayrol M, Vital M, Fièvre C, Druelles M, Arbion F, Body G, Lévêque J, Fritel X. Axillary lymph node metastases from unknown primary: A French multicentre study. Eur J Obstet Gynecol Reprod Biol 2018. [PMID: 29518639 DOI: 10.1016/j.ejogrb.2018.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of the study was to investigate the management and prognosis of axillary cancers from unknown primaries (CUPax). METHODS We included all patients with lesions described as axillary nodal metastases from an unknown primary referred to four French tertiary breast cancer centres between January 1988 and December 2012. The inclusion criteria comprised: no sign of primary breast cancer on clinical examination nor on imaging (mammography, ultrasonography and breast MRI) and no primary tumour identified elsewhere. RESULTS CUPax represented 1.8% of all metastatic axillary lymphadenopathies in our institutions. The overall survival rate was 71%, and 16.7% of patients had secondary inflammatory breast cancer signalling a posteriori that CUPax originated from the breast. Factors that favourably affected survival according to univariate analysis were: histological type of non specific adenocarcinoma (versus other types, p = 0.02), only one lymph node involved (versus several, p = 0.04), a normal CA153 serum-level (p = 0.02), no distant metastasis at initial assessment (p = 0.02), no secondary distant metastasis (p = 0.005) and radiotherapy to the ipsilateral breast/chest wall/lymph nodes (p = 0.04). On multivariate analysis including these factors, a histological type of non-specific adenocarcinoma (p = 0.03) and distant metastases (p = 0.03) were identified as independent factors affecting survival. CONCLUSION We believe that these results will shed light on current investigations and treatment of this rare entity.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; INSERM unit 1069, 10 boulevard Tonnellé, 37044, Tours, France; François Rabelais University, 2 boulevard Tonnellé, 37044, Tours, France.
| | - Marie Cayrol
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; François Rabelais University, 2 boulevard Tonnellé, 37044, Tours, France
| | | | - Claire Fièvre
- Department of Gynecology, Centre Hospitalier Universitaire de Poitiers, 6 rue de la milétrie, 86021, Poitiers cedex, France
| | - Marion Druelles
- Department of Gynecology, Centre Hospitalier Universitaire Anne de Bretagne, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes Cedex 2, France
| | - Flavie Arbion
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; François Rabelais University, 2 boulevard Tonnellé, 37044, Tours, France
| | - Jean Lévêque
- Department of Gynecology, Centre Hospitalier Universitaire Anne de Bretagne, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes Cedex 2, France
| | - Xavier Fritel
- Department of Gynecology, Centre Hospitalier Universitaire de Poitiers, 6 rue de la milétrie, 86021, Poitiers cedex, France
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Perineural spread of salivary duct carcinoma to the internal auditory canal. Case Rep Otolaryngol 2014; 2014:476317. [PMID: 25525541 PMCID: PMC4261793 DOI: 10.1155/2014/476317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022] Open
Abstract
Salivary duct carcinomas (SDCs) are high-grade malignant tumors exhibiting aggressive growth with early regional and distant metastasis. We report a case of SDC in a 63-year-old male with early recurrent disease in the cerebellopontine angle (CPA) after total parotidectomy and adjuvant radiotherapy. The tendency of the tumor to recur or metastasize despite radical surgical measures and radiotherapy continues to pose a therapeutic challenge.
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Lanitis S, Sivakumar S, Cathcart P, Rice A, Filippakis GM, Al Mufti R, Hadjiminas DJ. Axillary Metastatic Disease Secondary to Occult Breast Cancer: A Diagnostic and Therapeutic Dilemma. Breast J 2009:TBJ827. [PMID: 20030656 DOI: 10.1111/j.1524-4741.2009.00827.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sophocles Lanitis
- Breast Care Unit, Mary Stanford Wing, 5th floor, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
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Lanitis S, Behranwala K, Al-Mufti R, Hadjiminas D. Axillary metastatic disease as presentation of occult or contralateral breast cancer. Breast 2009; 18:225-7. [DOI: 10.1016/j.breast.2009.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 07/14/2009] [Indexed: 10/20/2022] Open
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Kinoshita S, Hirano A, Kobayashi S, Komine K, Kyoda S, Takeyama H, Uchida K, Morikawa T, Nagase J, Sakamoto G. Metachronous secondary primary occult breast cancer initially presenting with metastases to the contralateral axillary lymph nodes: report of a case. Breast Cancer 2009; 17:71-4. [PMID: 19259764 DOI: 10.1007/s12282-009-0097-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 01/09/2009] [Indexed: 02/06/2023]
Abstract
We report a rare case of a 64-year-old female with metachronous secondary primary left occult breast cancer initially presenting right axillary lymph node metastases. The patient, who had received breast-conserving therapy for left breast cancer at another hospital about 4.5 years ago, came to our hospital complaining of right axillary node swelling. After both breast and systemic examination, she received complete right axillary lymph node dissection. Just after the operation, she was diagnosed with right occult breast cancer by a review of the right axillary lymph nodes and previous left breast cancer. She was followed by radiation and systemic chemoendocrine therapies. One year after axillary lymph node dissection, mammography and ultrasonography showed a new lesion in her left breast. Core needle biopsy revealed similar findings to right axillary lymph node metastasis. After salvage surgery, the diagnosis was revised. We recommend that patients without clinical findings except for axillary lymph node metastasis, especially post-breast-conserving surgery followed by radiation therapy, should be considered not only as having ipsilateral but also contralateral occult breast cancer. If there is no evidence of a primary lesion, axillary lymph node dissection needs to be carried out, and the patient should be offered the choice of radiation therapy or mastectomy followed by proper systemic therapy.
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Affiliation(s)
- Satoki Kinoshita
- Department of Surgery, Jikei University Kashiwa Hospital, Kashiwashita, Chiba, Japan.
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