Prevalence of Ectopic Breast Tissue and Tumor: A 20-Year Single Center Experience

Concurrent Invasive Carcinoma and Fibroadenoma Arising from Bilateral Ectopic Breast Tissue in the Chest Wall: A Case Report and Literature Review

Ectopic breast tissue, which results from incomplete regression of the mammary line during embryogenesis, is observed in 0.2%-6% of the population. Carcinoma development in ectopic breast tissue, especially in the abdominal or chest wall, is rare. Here we present the unusual case of a 38-year-old woman with invasive ductal carcinoma in the ectopic breast tissue on the left side of the chest wall and concurrent fibroadenoma in the ectopic breast tissue on the right side. We also describe the US and MR findings of these masses.

A Case of Axillary Fibroadenoma That Grew Rapidly from Axillary Accessory Breast Tissue over 40 Days

Axillary accessory breast (AAB) occurs in 2%-6% of women. Like normal breast tissue, ABB can undergo changes, including periodic enlargement that can result in a palpable axillary mass. Fibroadenoma is the most common benign subcutaneous tumor of the breast: it occurs in approximately 25% of women and accounts for 50% of all breast biopsies. However, fibroadenoma in AAB is rare (2.6%). Here, we describe the case of a patient who was diagnosed first with left AAB on the basis of clinical and magnetic imaging resonance findings, and then 40 days later with fibroadenoma in left AAB by histopathology of the resected mass. The tumor, which had been undetectable at the initial visit, had transformed into a clinically obvious, hard, protruding mass at surgery. Thus, fibroadenomas originating from AAB can grow quickly, and imaging-based diagnosis should be confirmed with histology. Treatment should involve complete excision of the fibroadenoma and surrounding AAB.

Right Common Femoral Vein Invasion: A Unique Case of Inguinal Ectopic Breast Cancer

OBJECTIVES

Ectopic breast cancer may present anywhere in the milk line, from the axilla to the groin which is extremely rare in the inguinal region. Despite morphologic differences, ectopic breast tissue presents characteristics related to orthotopic breast tissue in terms of function and pathologic degeneration. The case report describes the treatment of a unique ectopic breast carcinoma which was located in the inguinal region with a common femoral vein invasion.

METHODS

We present a unique case of an ectopic breast carcinoma presenting in an unusual anatomic location along the milk line. The study was approved by the local Ethics Committee (protocol no: 12.01.2023-2023/02) Informed consent was obtained from the patient.

RESULTS

The patient is surgically treated and supplemented with neoadjuvant chemotherapy,radiotherapy and endocrine therapy. Histopathological examination revealed the diagnosis of invasive ductal carcinoma. The right common femoral vein was reconstructed with bovine pericardial patch after totally removal of the mass.

CONCLUSIONS

This report alerts the reader to be cognizant of the unusual location of an ectopic breast cancer which was detected in the inguinal region with a common femoral vein invasion and discusses the treatment, suggesting novel therapeutic advice that could bring considerable clinical advantages. A multidisciplinary approach should be warranted in such cases to confirm a complete remission.

Kajava Classification: The Person and the Research

The Kajava classification for ectopic breast tissue is still widely used, although it was published in 1915 in Finnish. This historical note sheds light on the person and research behind the classification. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Implications of a Supernumerary Nipple Breast Cancer in a BReast CAncer Sequence Variation Carrier: A Case Report

Supernumerary nipples develop on the chest and abdominopelvic regions along the embryonic milk line. Their anatomy varies from isolated accessory nipples to complete supernumerary nipples (accessory nipple, areola, and underlying glandular breast tissue). Patients with a pathogenic BReast CAncer (BRCA) sequence variation are at an increased cumulative risk of developing breast cancer, and it is the standard of care for them to be offered medical or surgical risk reduction. Given the relatively low prevalence of breast cancer within supernumerary nipples and ectopic glandular breast tissue, no current recommendations exist to guide multidisciplinary management of patients with BRCA sequence variations and ectopic breast tissue. Our case is of a 62-year-old female BRCA-1 carrier with a previous history of right breast cancer who developed a new primary breast cancer within a supernumerary nipple after undergoing surgical risk reduction. With no current consensus on the surgical management of supernumerary nipples in BRCA-1 carriers, our recommendation is to perform a thorough physical examination before risk-reducing operation. If supernumerary nipples or ectopic glandular breast tissue are present, wide-local excision of the tissue should be offered for more complete surgical risk reduction.

Misleading images of ductal carcinoma in situ: 4 lymph nodes with metastasis

Since sentinel lymph node examination became routine, findings of benign ectopic breast tissue in lymph nodes have increased. We report images of ductal carcinoma in situ (DCIS) in four lymph nodes in a 76-year-old woman with bilateral breast carcinoma. The right lumpectomy showed intermixed invasive lobular and ductal carcinoma, plus DCIS. 19 nodes were isolated in the axillary lymphadenectomy, 4 of which displayed solid and cribriform DCIS. Myosin and p63 immunohistochemical techniques were positive, suggesting an erroneous diagnosis of "metastatic DCIS". A further three cases of DCIS in lymph nodes have been previously reported, all with a distinct layer of myoepithelial cells with actin, myosin or p63. Biologically, these images of DCIS in lymph nodes are not credible and three major hypotheses have been proposed to explain these findings: Iatrogenic Mechanical Transport, Revertant DCIS, and primary DCIS of lymph nodes. We consider the first one the most plausible explanation. Our case is unique as several, rare findings are simultaneously observed. More new cases, together with additional immunohistochemical techniques and molecular testing on previous cases, are needed to find a definitive explanation of this histologic finding.

Unilateral Ectopic Breast Tissue in the Vulva - A Diagnostic Dilemma

Ectopic breast tissue is a rare condition caused by remnants of the mammary ridges that fail to involute during embryologic development. Clinical presentation of vulval breast tissue is highly variable and diagnosis is ultimately made by tissue biopsy and histopathological examination. Since this ectopic tissue serves no function, surgical excision is recommended. Vulval ectopic breast tissue is an extremely rare case, especially in midlife. Because of its rarity in occurrence and unusual site, here we report a case of unilateral ectopic breast tissue on the vulva in an adult midlife female.

Primary ectopic breast carcinoma: a case report

BACKGROUND

Ectopic breast tissue is present in 2-6% of women. Ectopic mammary tissue can experience physiological changes and the same pathological processes as the eutopic breast. Ectopic breast cancer represents an uncommon condition accounting for 0.3% of all breast neoplasms, and it is most frequently located in the axilla.

CASE REPORT

We report a rare case of a 57-year-old Tunisian woman who presented with a left-sided axillary mass evolving for about 1 month. The axillary ectopic breast tissue containing the mass was excised with axillary dissection. Pathology revealed a medullary multifocal carcinoma and metastasis was detected in two lymph nodes. She had local radiotherapy after six cycles of chemotherapy. She received herceptin therapy and hormonotherapy. After a 2-year follow-up, no evidence of local recurrence or distant metastases have been identified.

CONCLUSION

Ectopic breast carcinoma is a rare entity that should be the first diagnosis to be considered if an axillary lump is present in ectopic breast tissue. No particular guidelines on diagnosis and treatment are available. Therefore, physicians should be aware of this condition to avoid treatment delays. Once diagnosed, careful patient follow-up is essential because of the ambiguous natural history of this rare entity.

Axillary ectopic breast tissue in the adolescent

AIM

Ectopic breast tissue (EBT) includes a spectrum of disease that entails other entities based on the presence of glandular tissue, nipple, or areola. The diagnosis in adolescents is infrequent.

METHODS

A retrospective study was performed including girls with axillary EBT (class IV or V of Kajava's Classification) operated in 2006-2020. Imagining studies, clinical and surgical reports, and histopathology were reviewed.

RESULTS

Eleven girls from 13 to 16 years old were included. Two patients (18.2%) presented bilateral EBT. The most frequent clinical manifestation was 2-5 cm mass (100%), associating cyclic pain with menstruation (45%) and fluctuating volume (36%). Bilateral axillary ultrasonography allowed preoperative diagnosis. All of them were treated by open excision, through small incisions located in an axillary y fold. Clinical and aesthetic results were self-assessed as "very good", with normalization of the axillary y hollow and imperceptible scars. No recurrences were observed after one year of follow-up. An immediate postoperative hematoma was reported, which did not require drainage. Histopathology showed mature breast tissue without atypia.

CONCLUSIONS

Axillary accessory breasts must be included in differential diagnosis of pediatric axillary masses. Bilateral ultrasonography is recommended for the preoperative diagnosis. Excision through minimal incision at this age seems to be safe and effective.

Multicentric Breast Cancer of the Axillary and Pectoral Breasts: A Case Report and Literature Review

Multicentric cancer of the pectoral and ectopic breasts is extremely rare, and diagnosing this malignancy remains challenging because axillary breast cancer is easily misdiagnosed as lymph node metastasis. Moreover, there are no established treatment guidelines for this disease. We present our experience with a multicentric breast cancer patient who showed different responses to neoadjuvant chemotherapy (NAC) and underwent surgical treatments that differed from those in previous studies. In our case, the preoperative imaging of both lesions and subsequent core needle biopsy of each lesion were crucial, as these procedures confirm the diagnosis and help decide the chemotherapy regimen based on the subtype. After NAC, the patient underwent right breast-conserving surgery, sentinel lymph node biopsy (SLNB), and excision of accessory breast tissue in the right axilla. SLNB should be the initial step in staging multicentric breast cancer, unless imaging scan shows evidence of lymph node metastasis.

Ectopic Breast Tissue in the Inguinal Region: A Case Report and Suggestion of Indications for Excision

We report a rare case of ectopic breast tissue situated in a unique location. A 50-year-old female patient came to our institution complaining of a bulge in the inguinal area. CT was unremarkable other than a benign-looking conglomeration of lymph nodes around the inguinal canal. However, excisional biopsy proved otherwise, with strong expression of breast-related immunohistochemical markers on pathology. Based on histological findings, the diagnosis of ectopic breast tissue was made. Since the vast majority of ectopic breast tissue is found around the breast mound, axilla, and along the milk line, this case is peculiar in its location. This report shares our experience and provides indications for excision of incidental ectopic breast tissue.

Breast and Thyroid Surgery in 2021 and Beyond

Several studies in the literature report the association between breast and thyroid pathologies; however, the underlying causes (genetic, environmental, hormonal or immunological) have not yet been well explicated [...]

Metachronous bilateral ectopic breast carcinoma in the axilla: A case report and literature review

Bilateral ectopic axillary breast carcinoma is extremely rare. Here, we report the case of a 68-year-old woman who presented with a palpable mass in the right axilla. After ectopic breast carcinoma diagnosis, the patient underwent partial mastectomy and sentinel lymph node biopsy, followed by radiotherapy of the whole breast. Adjuvant endocrine therapy was administered for 5 years. Seven years after the first carcinoma diagnosis, the patient noticed a second tumor in the left axilla by herself at the age of 75 years. Core needle biopsy revealed second primary breast carcinoma of the axilla. She underwent partial mastectomy and sentinel lymph node biopsy followed by chemotherapy, radiotherapy, and endocrine therapy. No recurrence has been observed so far. Therefore, ectopic breast carcinoma should be treated as typical breast carcinoma.

Primary ectopic breast carcinoma in the axilla: A rare presentation and review of the literature

Ectopic breast tissue (EBT) develops as the result of the incomplete embryologic regression of the mammary ridge, which extends bilaterally from the anterior axilla folds to the inguinal folds in the fifth and sixth weeks of gestation. EBT is encountered in 0.3%-6% of women and 1%-3% of men and can be found anywhere along the milk line. It is subject to the same pathologic changes that affect the orthotopic breast. Primary carcinoma arising on the ectopic breast (PEBC) is a very rare occurrence accounting for 0.3%-0.6% of all breast cancers and is most frequently found in the axilla. Due to the rarity and atypical presentation of the disease, the diagnosis is often delayed. We herein present a very rare case of PEBC in the axilla along with a review of the literature. Any subcutaneous hypoechoic nodule located along the milk line without evidence of inflammation should raise concern for ectopic breast carcinoma. Accurate staging and differential diagnosis with detailed immunohistochemical analysis are required. No specific guidelines on diagnosis and treatment are available and the tumor is treated similarly to the orthotopic breast cancer of a similar stage. Physicians should be aware of this rare entity to avoid treatment delays.

Case of second primary breast cancer in ectopic breast tissue and review of the literature

Accessory breast tissue (ABT) is found in approximately 2%-6% of the female population and are subject to most of the physiological and pathological changes that occur in pectoral breast. Primary breast cancer occurring in ABT is a rare occurrence and a second primary breast cancer occurring in an accessory breast has never been reported. We report the case of a 60-year-old woman with a history of mastectomy for left breast cancer 5 years prior to presentation, who presented with an enlarging right axilla mass found to be a second primary breast cancer in an accessory tissue on biopsy. Many physicians are unfamiliar with the clinical presentation of accessory breast cancer due to the rarity of the condition and this ultimately results in delayed diagnosis and advanced disease at presentation. It is therefore prudent that physicians have a high index of suspicion when patients present with axillary masses.

Surgery for fibroadenoma arising from axillary accessory breast

BACKGROUND

Patients with fibroadenomas in axillary accessory breasts (AABs) have a palpable mass, cyclic axillary pain, and aesthetic concerns that must be addressed. We compared the baseline patient characteristics, AAB characteristics, and surgical outcomes of patients with AABs with and without fibroadenomas undergoing surgical excision. We also monitored the patients for recurrence of axillary fibroadenomas.

METHODS

This retrospective study involved 2310 women who underwent AAB excision from 2014 to 2019. Patients with and without a palpable fibroadenoma were divided into a fibroadenoma group and non-fibroadenoma group, respectively. All patients underwent complete excision of accessory mammary gland (AMG) tissue, including fibroadenomas in the AABs. We removed the fibroadenoma and the AMG tissue with a minimal axillary incision.

RESULTS

Thirty-nine patients had a palpable fibroadenoma in the AAB, and all patients in the fibroadenoma group had cyclic axillary pain and a palpable axillary mass. There were no significant differences in the patients' age, weight of the AMG tissue, liposuction volume, or fibroadenoma laterality between the two groups. The body mass index in the fibroadenoma group was lower than that in the non-fibroadenoma group (19.9 vs. 22.3 kg/m², respectively; P < 0.000). Concurrent fibroadenoma excision in a normal breast on the chest was performed more often in the fibroadenoma group than in the non-fibroadenoma group (35.9% (14/39) vs. 4.1% (92/2271), respectively; P < 0.000). The mean fibroadenoma size was 2.1 cm (range, 1.1-9.1 cm). All patients were satisfied with the degree of postoperative pain relief, disappearance of palpable lesions, and cosmetic improvement. No patients developed fibroadenoma recurrence.

CONCLUSIONS

Complete excision of the AMG tissue and fibroadenoma is appropriate in patients with an AAB with a fibroadenoma. Surgeons should also consider the high incidence of concurrent fibroadenomas in the normal breasts on the chest.

[Pathology of the nipple-areola complex : Part II. Tumors, tumor-like lesions, and supernumerary breast lesions]

The nipple-areola complex is the origin of various morphologically distinct tumors and tumor-like lesions, which can be delineated from the special structures of the nipple, in particular the intramammary ducts, skin-appendages, and the intramammary stroma. Benign tumors are most frequent and this includes epithelial tumors such as mammary adenoma and syringomatous tumor of the nipple. Less commonly observed are benign mesenchymal tumors such as leiomyoma of the nipple, or tumor-like lesions like pseudo-lymphoma. With excess formations of the nipple, the different forms of polythelia and polymastia have to be considered.

Management of ipsilateral supernumerary nipple at time of breast cancer diagnosis

Supernumerary breast components occur predominantly between the breast and umbilicus. Carcinoma of this ectopic, or accessory breast tissue (ABT), is exceedingly rare, accounting for <1% of breast cancer cases. Historically, ectopic breast carcinoma was considered aggressive with poor outcome. In 1995, Evans et al reported 90 cases spanning from 1929 to 1993 with a 9.4% survival beyond 4 years. More contemporary studies reveal improvement in both treatment and survival. There is currently no consensus on whether prophylactic excision of an ipsilateral supernumerary nipple at the time of initial breast cancer diagnosis is necessary. The following describes a patient with an ipsilateral tumor uniquely located within her supernumerary nipple 5 years after mastectomy.

Orbital metastases from breast cancer: A single institution case series

BACKGROUND AND OBJECTIVES

Among orbital tumors, metastatic lesions have a prevalence of 1% to 13%; on the other hand, breast cancer is the most common malignancy causing orbital metastases. The aim of this study is to present our experience dealing with orbital metastases caused by breast cancer, to assess characteristics and clinic-pathological data of patients suffering from this rare occurrence and to find indexes related with their prognosis and survival.

METHODS

Records of 28 patients diagnosed with orbital metastases from breast cancer at the Department of Ophthalmology, Humanitas Clinical and Research Centre of Milano over a 27-year period (1992-2018) were retrieved and analyzed.

RESULTS

Mean patients' age at breast cancer diagnosis was 56.29 ± 14.63 years. Mean time interval between breast cancer diagnosis and orbital metastasis occurrence was 5 ± 4.17 years. All lesions were estrogen receptor-positive; 79% of patients harbored progesterone receptor-positive lesions. Interestingly, the majority of deceased patients presented orbital lesions with MIB-1 index >50% (P = .0265) and had concomitant lung metastases (P = .0452).

CONCLUSIONS

The occurrence of orbital metastasis from breast cancer represents a challenging finding. Patients' clinical picture can include exophthalmos, edema, tumefaction, proptosis and/or diplopia. Significant symptomatic improvement can be achieved through surgery and other adjuvant treatments, such as radiation therapy and chemotherapy.

Intraoperative sonography for nonpalpable breast lesions: Additional indications for a consolidate technique

This prospective study evaluated the intraoperative ultrasound scan (IUSS) for nonpalpable breast lesions' detection. A total of 108 consecutive female patients underwent surgery using IUSS: Frozen sections demonstrated clear margins in 95.5% of neoplastic patients. Only four (4.5%) patients underwent local re-excision in the same operation. IUSS demonstrated to be quick, accurate, useful, effective, and safe for the intraoperative management of neoplastic nonpalpable breast lesions when performed by a surgeon who has undergone US training, particularly for people in whom alternative approaches can show some limitations due to contraindications or because of scheduling constraints, costs, and patient discomfort.

Recurrent vulvar breast fibroadenoma: presentation of a rare clinical condition

Vulvar fibroadenoma is an ectopic mammary-like fibroepithelial tumor of undetermined pathogenesis. Surgery is usually the primary option of treatment for this condition. Recurrent vulvar fibroadenoma is a rare clinical condition, and it has therapeutic challenges for surgeons and pathologists. Three cases of recurrent vulvar fibroadenoma were reviewed and studied (at 25, 39, and 18 years old for each case). We summarize and report our clinical experience on recurrent vulvar fibroadenoma. All patients were surgically managed with a satisfactory outcome and were followed up for at least 6 months. This is the first case series to address a rare clinical condition in vulvar fibroadenoma. Tumor size, conditions of high hormonal exposure, iatrogenic issues, and residual lesions contribute to recurrence. The standard surgical strategy for vulvar fibroadenoma is important for lowering the risk of local recurrence.

Axillary Accessory Breast: Optimal Time for Operation

BACKGROUND

Accessory breasts are usually located in the axilla. Symptoms associated with an axillary accessory breast (AAB) may newly develop or worsen after pregnancy. After childbirth, AAB engorgement and hyperplasia may occur due to milk formation. We evaluated the optimal time for AAB excision and assessed variations in clinical presentations and surgical outcomes associated with pregnancy.

METHODS

In total, 540 women whose symptoms began from puberty and underwent AAB excision were retrospectively analyzed. Group 1 comprised 416 patients who underwent operations before pregnancy, and Group 2 comprised 124 patients who underwent operations after childbirth. AABs were classified according to the Damsoyu-Lee (DL) classification. Satisfaction was measured by pain and cosmesis 3 months postoperatively.

RESULTS

Group 2 had more patients with severe symptoms [DL class II (n = 8, 6.5%) and III (n = 15, 12.1%)] than Group 1 (p = 0.049). The specimen weight and liposuction volume were greater in Group 2. The reoperation rate was also higher in Group 2 [loosening skin excision (n = 4, 3.2%) and remnant gland excision (n = 3, 2.4%)] (p = 0.032). In Group 2, 31 (25%) patients had AAB engorgement after childbirth and 7 (5.6%) had milk secretion from the accessory nipple after childbirth. The overall satisfaction score was lower in Group 2 than 1.

CONCLUSIONS

Pregnancy may cause accessory breast gland hyperplasia. After childbirth, symptoms such as AAB engorgement and milk secretion from the accessory nipple may occur. The optimal timing for operation for AAB appears to be before the onset of pregnancy because of lower reoperation rates and greater patient satisfaction.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Paget's disease of ectopic breast]

BACKGROUND

Paget's disease of the breast is rare, even more so when it occurs in a supernumerary breast since diagnosis is delayed due to lack of exploration and ignorance of the pathology of ectopic breast. Based on an original clinical case, we provide a clinical update concerning ectopic breast and ectopic carcinoma, including Paget's disease.

PATIENTS AND METHODS

A 44-year-old woman had complained of pain in the area of her supernumerary breast for several months. The ultrasound examination was normal but the unexplained symptoms led to performance of an excision biopsy of the lesion. This showed strictly intra-epidermal Paget's disease measuring 2mm, without any underlying carcinoma. A wider excision was performed. Follow-up at one year showed no recurrence.

DISCUSSION

An ectopic breast, present in 6 % of the population, is often ignored, despite being subject to the same diseases as anatomical breasts: it is at the origin of 0.6 % of breast cancers. Paget's disease is a rare in situ adenocarcinoma comprising fewer than 3 % of cases of breast cancer. It is extremely rare in ectopic breast. Ours is only the fourth reported case in the literature. This case is original because of the lack of objective clinical signs. Subjective symptoms such as pain, tingling, burning sensation and pruritus related to the supernumerary breast must be taken into consideration in order to enable early diagnosis of Paget's disease. Exploration by ultrasound and mammography generally appears flawed. Breast MRI may be useful but is not performed routinely. A promising future approach may consist of confocal microscopy screening of all ectopic breasts with areola or nipple patches, since this method enables the visualization of Paget cells and their organization.