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Afzal RJ, Basree MM, Howard SP, Xu J, Wilke LG, Anderson BM. Mammary Paget's Disease as a Sign of Local Recurrence Two Decades Following Breast Conservation and Adjuvant Therapy for Early Stage Breast Cancer. Cureus 2024; 16:e61521. [PMID: 38957233 PMCID: PMC11218596 DOI: 10.7759/cureus.61521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024] Open
Abstract
Reports of mammary Paget's disease (MPD) as a manifestation of breast cancer recurrence are rare. MPD presents a particular challenge when emerging more than two decades after a breast cancer treated with evidence-based therapy. There is a broad spectrum of non-malignant causes for dermatitis of the nipple during the initial presentation that may delay cancer work-up. This case highlights the MPD work-up and management in the context of a personal history of breast cancer. This unique clinical presentation emphasizes the importance of vigilant cancer surveillance for timely intervention, especially for a presumed cured cancer.
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Affiliation(s)
- Rimsha J Afzal
- Medical Education, University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, USA
| | - Mustafa M Basree
- Radiation Oncology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Steven P Howard
- Radiation Oncology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Jin Xu
- Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Lee G Wilke
- Breast Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Bethany M Anderson
- Radiation Oncology, University of Wisconsin School of Medicine and Public Health, Madison, USA
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Terasaki A, Bando H, Ueda A, Okazaki M, Hashimoto S, Iguchi-Manaka A, Kondo Y, Hara H. Local recurrence of breast cancer histologically resembling Paget disease presumably due to needle tract seeding: a case report. Int Cancer Conf J 2023; 12:143-148. [PMID: 36896205 PMCID: PMC9989070 DOI: 10.1007/s13691-023-00594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/12/2023] [Indexed: 02/25/2023] Open
Abstract
Seeding of cancer cells along the needle tract during core needle biopsy is a well-known phenomenon, with a reported frequency of between 22 and 50% [Hoorntje et al. in Eur J Surg Oncol 30:520-525, 2004;Liebens et al. in Maturitas 62:113-123, 2009;Diaz et al. in AJR Am J Roentgenol 173:1303-1313, 1999;]. Local recurrence due to needle tract seeding is rare because the immune system eliminates the cancer cells in most cases. In addition, most local recurrences due to needle tract seeding occur as invasive carcinoma after diagnosis of invasive ductal carcinoma of the breast or mucinous carcinoma, and needle tract seeding due to noninvasive carcinoma is uncommon. We herein report a rare case of local breast cancer recurrence histologically resembling Paget disease, presumably due to needle tract seeding after core needle biopsy for diagnosis of ductal carcinoma in situ of the breast. After receiving a diagnosis of ductal carcinoma in situ, the patient underwent skin-sparing mastectomy and breast reconstruction with a latissimus dorsi musculocutaneous flap. The pathological study showed ER/PgR-negative ductal carcinoma in situ, and no postoperative radiation therapy or systemic therapy was administered. Six months after the surgery, the patient had a breast cancer recurrence histologically resembling Paget disease, presumably in the scar of her core needle biopsy. The pathological study showed Paget disease localized in the epidermis, no invasive carcinoma, and no lymph node metastasis. It was morphologically similar to the primary lesion and was diagnosed as a local recurrence due to needle tract seeding.
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Affiliation(s)
- Azusa Terasaki
- Department of Breast-Thyroid-Endocrine Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki Japan
| | - Hiroko Bando
- Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki Japan
| | - Aya Ueda
- Department of Breast-Thyroid-Endocrine Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki Japan
| | - Mai Okazaki
- Department of Breast-Thyroid-Endocrine Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki Japan
| | - Sachie Hashimoto
- Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki Japan
| | - Akiko Iguchi-Manaka
- Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki Japan
| | - Yuzuru Kondo
- The Department of Diagnostic Pathology, National Hospital Organization Kasumigaura Medical Center, Tsuchiura, Ibaraki Japan
| | - Hisato Hara
- Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki Japan
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Ozaki Y, Yoshimura A, Sawaki M, Hattori M, Kotani H, Adachi Y, Kataoka A, Sugino K, Horisawa N, Endo Y, Nozawa K, Sakamoto S, Takatsuka D, Okumura S, Maruyama Y, Iwata H. The significance of biopsy scar excision at the time of skin- or nipple-sparing mastectomy with immediate breast reconstruction. Jpn J Clin Oncol 2021; 51:1212-1218. [PMID: 33942068 PMCID: PMC8326383 DOI: 10.1093/jjco/hyab065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Neoplastic seeding (NS) can occur after tissue biopsy, which is a clinical issue especially in mastectomy with immediate reconstruction. This is because postoperative radiation is not usually given and local recurrence of preserved skin flap may increase. The purpose of this study is to investigate the importance of preoperative evaluation of NS and the validity of biopsy scar excision. PATIENTS AND METHODS We retrospectively analysed 174 cases of mastectomy with immediate breast reconstruction. The primary endpoint is the frequency of clinical and pathological NS and the secondary endpoint is the problem of excision of needle biopsy site. RESULTS Three cases (1.7%) had preoperative clinical findings of NS. Pathological examination revealed NS in all three cases. Biopsy scars could be excised in 115 cases among 171 cases without clinical NS. Pathological NS was found in 1 of 66 (1.5%) cases of which pathological examination was performed. Biopsy scars could not be excised in the remaining 56 cases: the biopsy scar could not be identified in 41 cases, and there was concern about a decrease in flap blood flow after excision in 15 cases. In 12 of these 15 cases, the scars were close to the skin incision; excision of these scars might have triggered skin necrosis between the incision and the biopsy scar excision site. No postoperative complications were observed. CONCLUSIONS It is important to preoperatively evaluate clinical NS, and biopsy scars should be excised in clinical NS cases. Even in cases without clinical NS, biopsy scar excision should be considered. It is also important to perform a biopsy in consideration of the incision design for reconstructive surgery.
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Affiliation(s)
- Yuri Ozaki
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Akiyo Yoshimura
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Haruru Kotani
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Yayoi Adachi
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Ayumi Kataoka
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Kayoko Sugino
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Nanae Horisawa
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Yuka Endo
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Kazuki Nozawa
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Shoko Sakamoto
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Daiki Takatsuka
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Seiko Okumura
- Department of Plastic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Yoko Maruyama
- Department of Plastic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
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Wen S, Liang Y, Kong X, Liu B, Ma T, Zhou Y, Jiang L, Li X, Yang Q. Application of preoperative computed tomographic lymphography for precise sentinel lymph node biopsy in breast cancer patients. BMC Surg 2021; 21:187. [PMID: 33836721 PMCID: PMC8033684 DOI: 10.1186/s12893-021-01190-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/01/2021] [Indexed: 12/17/2022] Open
Abstract
Background In light of the extensive application of sentinel lymph node biopsy (SLNB) in clinically node-negative breast cancer patients and the recently investigated failure of SLNB after lumpectomy, it has become important to explore methods for preoperative mapping of sentinel lymph nodes (SLNs) and their lymphatics to direct precise SLNB and improve the identification rate of SLNs. Methods Twenty-seven patients with suspected breast cancer based on the results of the clinical examination and imaging were enrolled in the study. Computed tomographic lymphography (CTLG) followed by CT three-dimensional reconstruction was performed to determine the localization of SLNs and lymphatics on the body surface preoperatively. Intraoperatively combined staining with methylene blue and indocyanine green was used to evaluate the accuracy and feasibility of CTLG. Results SLNs and lymphatics from the breast were identified using CTLG in all patients, and preoperative SLNs and lymphatics localization on the body surface showed a significant role in the selection of operative incision and injection points. The accuracy rate of SLN and lymphatic detection by CTLG was 92.6% compared with intraoperatively combined staining. Moreover, preoperative CTLG performed well in SLN number detection, and the accuracy rate was 95.2%. Conclusion We evaluate the procedure and application of preoperative CTLG in the superficial localization of SLNs and lymphatics, which may lead to a decreased incidence of cutting off the lymphatics of SLNs and consequently more rapid and accurate SLN detection. This method promotes personalized SLN mapping, providing detailed information about the number and anatomical location of SLNs and lymphatics for adequate surgical planning for breast cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01190-7.
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Affiliation(s)
- Shishuai Wen
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiran Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Xiaoli Kong
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Baofeng Liu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Tingting Ma
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Yeqing Zhou
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Liyu Jiang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Xiaoyan Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan, 250012, Shandong, China. .,Pathology Tissue Bank, Qilu Hospital of Shandong University, Jinan, China. .,Research Institute of Breast Cancer, Shandong University, Jinan, China.
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Choi S, Kim EK, Kong J, Gong G, Shin HJ, Lee YJ, Son BH, Ahn SH, Lee JW. Recurrence of Breast Carcinoma as Paget's Disease of the Skin along the Core Needle Biopsy Tract after Skin-Sparing Mastectomy. J Breast Cancer 2020; 23:224-229. [PMID: 32395381 PMCID: PMC7192744 DOI: 10.4048/jbc.2020.23.e16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/23/2020] [Indexed: 12/02/2022] Open
Abstract
We report a case of recurrence as Paget's disease at the core needle biopsy (CNB) entry site in a patient with microinvasive ductal carcinoma who underwent nipple-areola-skin sparing mastectomy (NASSM) and autologous reconstruction. Clinically diagnosed recurrences associated with previous needle procedures for malignant breast lesions are rare and usually occur in patients who have not received radiation therapy. The present case involved local recurrence at the skin puncture site of a patient diagnosed based on CNB findings who underwent NASSM without receiving radiation therapy. Although the removal of the CNB tract with resected breast tissue is not always emphasized, the skin puncture site should be recorded to detect abnormal skin changes after surgery for the timely detection and management of complications.
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Affiliation(s)
- Soojeong Choi
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Eun Key Kim
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Joonseog Kong
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Gyungyub Gong
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hee Jung Shin
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Young Joo Lee
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sei Hyun Ahn
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Kong YC, Bhoo-Pathy N, O’Rorke M, Subramaniam S, Bhoo-Pathy NT, See MH, Jamaris S, Teoh KH, Bustam AZ, Looi LM, Taib NA, Yip CH. The association between methods of biopsy and survival following breast cancer: A hospital registry based cohort study. Medicine (Baltimore) 2020; 99:e19093. [PMID: 32028433 PMCID: PMC7015568 DOI: 10.1097/md.0000000000019093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 01/31/2023] Open
Abstract
Percutaneous biopsy in breast cancer has been associated with an increased risk of malignant cell seeding. However, the importance of these observations remains obscure due to lack of corroborating evidence from clinical studies. We determined whether method of biopsy is associated with breast cancer survival. This hospital registry-based cohort study included 3416 non-metastatic breast cancer patients diagnosed from 1993 to 2011 in a tertiary setting. Factors associated with biopsy methods were assessed. Multivariable Cox regression analysis was used to determine the independent prognostic impact of method of biopsy. Overall, 990 patients were diagnosed by core needle biopsy (CNB), 1364 by fine needle aspiration cytology (FNAC), and 1062 by excision biopsy. Excision biopsy was significantly associated with more favorable tumor characteristics. Radiotherapy modified the prognostic impact of biopsy method (Pinteraction < .001). Following multivariable analysis, excision biopsy was consistently associated with lower risk of mortality compared to FNAC in women receiving adjuvant radiotherapy (adjusted hazard ratio: 0.81, 95%CI: 0.66-0.99), but not in those who did not receive adjuvant radiotherapy (adjusted hazard ratio: 0.87, 95%CI: 0.65-1.17). While the risk of mortality was not different between patients undergoing FNAC and CNB when radiotherapy is administered, in the absence of radiotherapy, CNB was associated with higher risk of mortality than FNAC (adjusted hazard ratio: 1.57, 95%CI: 1.16-2.12). Given that our results contradict with findings of previous clinical studies assessing the prognostic impact of method of biopsy in women with breast cancer, further studies are warranted.
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Affiliation(s)
- Yek-Ching Kong
- Clinical Epidemiology Unit, National Clinical Research Centre, Level 3, Dermatology Block, Kuala Lumpur Hospital
| | - Nirmala Bhoo-Pathy
- Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Michael O’Rorke
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital Site, Belfast, UK
| | - Shridevi Subramaniam
- Clinical Epidemiology Unit, National Clinical Research Centre, Level 3, Dermatology Block, Kuala Lumpur Hospital
| | - Nanthini T. Bhoo-Pathy
- Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Anita Z. Bustam
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur
| | | | | | - Cheng-Har Yip
- Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
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Zhao Z, Tay TKY, Agrawal R, Tan VKM, Tan YY, Tan PH. Intraepidermal malignancy in breast skin: A tale of two tumours. HUMAN PATHOLOGY: CASE REPORTS 2018. [DOI: 10.1016/j.ehpc.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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