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Abecia Martínez EI, Sanromán AC, Leon L, Monge LS, Zarza BE. Misleading images of ductal carcinoma in situ: 4 lymph nodes with metastasis. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2023; 56:252-260. [PMID: 37879822 DOI: 10.1016/j.patol.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 10/27/2023]
Abstract
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.
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Affiliation(s)
| | | | - Liliana Leon
- Hospital Universitario Miguel Servet (Pathology), Zaragoza, Spain
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Terada M, Adachi Y, Sawaki M, Hattori M, Yoshimura A, Naomi G, Kotani H, Iwase M, Kataoka A, Onishi S, Sugino K, Mori M, Horisawa N, Sasaki E, Yatabe Y, Iwata H. Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes. Breast Cancer Res Treat 2018; 172:1-7. [PMID: 30030707 DOI: 10.1007/s10549-018-4898-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/26/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Occult breast cancer (OBC) is classified as a carcinoma of unknown primary, and involves axillary lymphadenopathy and is histologically consistent with metastatic breast cancer. OBC has been conventionally considered as a metastatic lymph node lesion, the origin of which is an undetectable breast tumor. Therefore, OBC patients would usually have undergone axillary lymph node dissection, and mastectomy or whole breast radiotherapy (WBRT). However, majority of OBC reports have been based on cases that were diagnosed during a period when diagnostics was still relatively primitive, and when magnetic resonance imaging was not yet a standard preoperative assessment. Therefore, there have been many false negatives in the breast based on preoperative assessment. METHODS We herein hypothesize that the origin of OBC is ectopic breast tissue present in axillary lymph nodes (ALNs). If our hypothesis is true, mastectomy and WBRT may be unnecessary for OBC patients. RESULTS Our hypothesis is supported by several findings. First, advances in radiological imaging have suggested that a primary breast tumor is absent in OBC patients. Second, proliferative breast lesions arising from ectopic breast present in ALNs have been reported. Lastly, cellular subtypes in OBC based on immunohistochemistry are of various types including ordinary breast cancer and the prognosis is not worse than stage II breast cancer. CONCLUSION It is important to distinguish between "primary" OBC in ALNs and "metastatic" OBC from micro-primary breast tumor. Further studies are required to determine if omission of mastectomy and WBRT is acceptable.
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Affiliation(s)
- Mitsuo Terada
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Yayoi Adachi
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Akiyo Yoshimura
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Gondo Naomi
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Haruru Kotani
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Madoka Iwase
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Ayumi Kataoka
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Sakura Onishi
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Kayoko Sugino
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Makiko Mori
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Nanae Horisawa
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
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Xie Y, Huang J, Xiao D, Zhong M. Male breast cancer arising in ectopic axillary breast tissue: A diagnostic dilemma. Oncol Lett 2013; 5:1931-1934. [PMID: 23833669 PMCID: PMC3701032 DOI: 10.3892/ol.2013.1300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 03/27/2013] [Indexed: 01/01/2023] Open
Abstract
Male breast cancer arising in ectopic axillary breast tissue is a rare occurrence and few cases have been reported in the literature. Due to its rarity, male axillary breast cancer is easy to misdiagnose. As for adenocarcinoma in the axilla, it is difficult to identify whether the origin is the mammary tissue or the skin appendages, particularly in cases where there is a poor differentiation. The present study reports the case of a male patient with a right axillary lesion that had been present for 6 months. A histological evaluation revealed the features of a poorly-differentiated adenocarcinoma with regards to the pathological report. The patient was diagnosed with a metastatic adenocarcinoma with unknown primary origin. However, following 4 cycles of intensive chemotherapy, the patient experienced bone metastasis while the local lesion was in partial remission. Further immunohistochemistry confirmed its mammary origin. There is limited literature relating to male ectopic axillary breast cancer, and a high probability of misdiagnosis of this disease.
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Affiliation(s)
- Yangchun Xie
- Departments of Oncology, Central South University Xiangya Hospital, Changsha, Hunan 410008, P.R. China
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Zynger DL, McCallum JC, Everton MJ, Yeldandi AV, Susnik B. Paracortical axillary sentinel lymph node ectopic breast tissue. Pathol Res Pract 2009; 205:427-32. [PMID: 19168294 DOI: 10.1016/j.prp.2008.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 08/28/2008] [Accepted: 12/02/2008] [Indexed: 11/28/2022]
Abstract
Benign glandular inclusions in axillary lymph nodes are uncommon, and their presence in axillary sentinel lymph nodes is exceptionally rare. The possibility of over-staging due to misinterpretation of glandular inclusions as metastatic carcinoma is a concerning issue. We present a 54-year-old female with high grade ductal carcinoma in-situ undergoing simple mastectomy with sentinel lymph node biopsy. Permanent sections of the sentinel lymph node revealed scarce naked small glands without surrounding stroma scattered in the paracortex in the superficial level. Deeper levels showed glands spanning a much larger area (2mm), with bland ducts and tubules separated by abundant stroma. The myoepithelial layer was visible and was immunohistochemically confirmed. A final diagnosis of benign ectopic breast tissue within an axillary sentinel lymph node was rendered. Previous studies described axillary sentinel lymph nodes with glandular inclusions separated by stroma or subcapsular in location. It has been suggested that paracortical location and absence of stroma are characteristics of metastasis. As demonstrated in our report, benign inclusions may be paracortical and lack surrounding stroma. We recommend that glandular inclusions should be a diagnostic consideration for cases in which paracortically located naked glands do not histologically resemble the corresponding primary tumor.
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Affiliation(s)
- Debra L Zynger
- Department of Pathology, Feinberg 7-325B, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, 251 East Huron Street, Chicago, IL 60611, USA.
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