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Breast cancer from the excisional scar of a benign mass.

Kim MJ, Kim EK, Lee JY, Youk JH, Park BW, Kim H, Oh KK - Korean J Radiol (2007 May-Jun)

Bottom Line: Breast cancer developing from a surgical scar is rare; this type of malignancy has been reported in only 12 cases to date.Two years previously, the patient underwent surgery and radiotherapy for invasive ductal carcinoma of the contralateral breast.The initial appearance of the scar was similar to fat necrosis; it was observed to be progressively shrinking on follow-up sonography.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Breast cancer developing from a surgical scar is rare; this type of malignancy has been reported in only 12 cases to date. Herein, we report on a 52-year-old female who developed infiltrating ductal carcinoma in a surgical scar following excision of a benign mass. Two years previously, the patient underwent surgery and radiotherapy for invasive ductal carcinoma of the contralateral breast. The initial appearance of the scar was similar to fat necrosis; it was observed to be progressively shrinking on follow-up sonography. On the two year follow-up ultrasound, the appearance changed, an angular margin and vascularity at the periphery of the scar were noted. A biopsy and subsequent excision of the scar were performed; the diagnosis of infiltrating ductal carcinoma of the scar was confirmed.

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A. Sonography from June 2003 shows a 12 mm irregular mass (calipers) at the medial portion of the left breast.B. The histopathologic findings from the left breast surgical specimen shows an intraductal papilloma (Hematoxylin & Eosin staining, ×100).C. Follow-up sonography, from March 2004, shows an irregular mass with internal heterogeneous hyperechogenicity. An anechoic portion (thick arrow), suggestive of fat necrosis, was noted, and the mass abutted the thickened skin (thin arrow) from the previous excision.D. The third follow-up sonogram from March 2005, demonstrates that the irregular mass decreased in size, from 15 mm to 10 mm.E. The fourth follow-up sonography from September 2005, showing that the mass had developed a new angular margin (arrows) in one portion (right split-screen image: transverse view, left split-screen image: longitudinal view).F. On Doppler ultrasound, penetrating vascularity (arrow) was detected.G. On compression mammography of the craniocaudal view, a 4 mm mass (arrow) is seen just beneath the skin scar.H. On tissue confirmation, the surgical specimen demonstrates a 4 mm infiltrating ductal carcinoma (arrows) in the peripheral portion of theexcised specimen with marked fibrosis and foreign body reaction in the majority of the specimen (Hematoxylin & Eosin staining, ×100).
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Figure 1: A. Sonography from June 2003 shows a 12 mm irregular mass (calipers) at the medial portion of the left breast.B. The histopathologic findings from the left breast surgical specimen shows an intraductal papilloma (Hematoxylin & Eosin staining, ×100).C. Follow-up sonography, from March 2004, shows an irregular mass with internal heterogeneous hyperechogenicity. An anechoic portion (thick arrow), suggestive of fat necrosis, was noted, and the mass abutted the thickened skin (thin arrow) from the previous excision.D. The third follow-up sonogram from March 2005, demonstrates that the irregular mass decreased in size, from 15 mm to 10 mm.E. The fourth follow-up sonography from September 2005, showing that the mass had developed a new angular margin (arrows) in one portion (right split-screen image: transverse view, left split-screen image: longitudinal view).F. On Doppler ultrasound, penetrating vascularity (arrow) was detected.G. On compression mammography of the craniocaudal view, a 4 mm mass (arrow) is seen just beneath the skin scar.H. On tissue confirmation, the surgical specimen demonstrates a 4 mm infiltrating ductal carcinoma (arrows) in the peripheral portion of theexcised specimen with marked fibrosis and foreign body reaction in the majority of the specimen (Hematoxylin & Eosin staining, ×100).

Mentions: In June 2003, a 50-year-old woman presented with a palpable mass in the subareolar region of her right breast with erythematous skin changes. She underwent mammography and sonography. A 2.5-cm diameter tumor with an irregular shape and high density on mammography was identified in the right breast, and a nonpalpable 1.2 cm irregular isoechogenic mass with an angular margin (Fig. 1A) was found in the left breast on sonography. A core biopsy revealed that the mass in the right breast was an infiltrating ductal carcinoma, and the mass in the left breast was an intraductal papilloma. The patient subsequently underwent five cycles of neoadjuvant chemotherapy with the adriamycin and taxol regimen followed by a right modified radical mastectomy and a right axillary node dissection in November 2003 (TNM staging: T2N3aM0). Excision of the mass in the left breast was performed under ultrasound guidance. Histopathology revealed an intraductal papilloma (Fig. 1B). The patient underwent, an additional, three cycles of adjuvant chemotherapy with the taxol regimen and radiation therapy to the right chest wall region.


Breast cancer from the excisional scar of a benign mass.

Kim MJ, Kim EK, Lee JY, Youk JH, Park BW, Kim H, Oh KK - Korean J Radiol (2007 May-Jun)

A. Sonography from June 2003 shows a 12 mm irregular mass (calipers) at the medial portion of the left breast.B. The histopathologic findings from the left breast surgical specimen shows an intraductal papilloma (Hematoxylin & Eosin staining, ×100).C. Follow-up sonography, from March 2004, shows an irregular mass with internal heterogeneous hyperechogenicity. An anechoic portion (thick arrow), suggestive of fat necrosis, was noted, and the mass abutted the thickened skin (thin arrow) from the previous excision.D. The third follow-up sonogram from March 2005, demonstrates that the irregular mass decreased in size, from 15 mm to 10 mm.E. The fourth follow-up sonography from September 2005, showing that the mass had developed a new angular margin (arrows) in one portion (right split-screen image: transverse view, left split-screen image: longitudinal view).F. On Doppler ultrasound, penetrating vascularity (arrow) was detected.G. On compression mammography of the craniocaudal view, a 4 mm mass (arrow) is seen just beneath the skin scar.H. On tissue confirmation, the surgical specimen demonstrates a 4 mm infiltrating ductal carcinoma (arrows) in the peripheral portion of theexcised specimen with marked fibrosis and foreign body reaction in the majority of the specimen (Hematoxylin & Eosin staining, ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627412&req=5

Figure 1: A. Sonography from June 2003 shows a 12 mm irregular mass (calipers) at the medial portion of the left breast.B. The histopathologic findings from the left breast surgical specimen shows an intraductal papilloma (Hematoxylin & Eosin staining, ×100).C. Follow-up sonography, from March 2004, shows an irregular mass with internal heterogeneous hyperechogenicity. An anechoic portion (thick arrow), suggestive of fat necrosis, was noted, and the mass abutted the thickened skin (thin arrow) from the previous excision.D. The third follow-up sonogram from March 2005, demonstrates that the irregular mass decreased in size, from 15 mm to 10 mm.E. The fourth follow-up sonography from September 2005, showing that the mass had developed a new angular margin (arrows) in one portion (right split-screen image: transverse view, left split-screen image: longitudinal view).F. On Doppler ultrasound, penetrating vascularity (arrow) was detected.G. On compression mammography of the craniocaudal view, a 4 mm mass (arrow) is seen just beneath the skin scar.H. On tissue confirmation, the surgical specimen demonstrates a 4 mm infiltrating ductal carcinoma (arrows) in the peripheral portion of theexcised specimen with marked fibrosis and foreign body reaction in the majority of the specimen (Hematoxylin & Eosin staining, ×100).
Mentions: In June 2003, a 50-year-old woman presented with a palpable mass in the subareolar region of her right breast with erythematous skin changes. She underwent mammography and sonography. A 2.5-cm diameter tumor with an irregular shape and high density on mammography was identified in the right breast, and a nonpalpable 1.2 cm irregular isoechogenic mass with an angular margin (Fig. 1A) was found in the left breast on sonography. A core biopsy revealed that the mass in the right breast was an infiltrating ductal carcinoma, and the mass in the left breast was an intraductal papilloma. The patient subsequently underwent five cycles of neoadjuvant chemotherapy with the adriamycin and taxol regimen followed by a right modified radical mastectomy and a right axillary node dissection in November 2003 (TNM staging: T2N3aM0). Excision of the mass in the left breast was performed under ultrasound guidance. Histopathology revealed an intraductal papilloma (Fig. 1B). The patient underwent, an additional, three cycles of adjuvant chemotherapy with the taxol regimen and radiation therapy to the right chest wall region.

Bottom Line: Breast cancer developing from a surgical scar is rare; this type of malignancy has been reported in only 12 cases to date.Two years previously, the patient underwent surgery and radiotherapy for invasive ductal carcinoma of the contralateral breast.The initial appearance of the scar was similar to fat necrosis; it was observed to be progressively shrinking on follow-up sonography.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Breast cancer developing from a surgical scar is rare; this type of malignancy has been reported in only 12 cases to date. Herein, we report on a 52-year-old female who developed infiltrating ductal carcinoma in a surgical scar following excision of a benign mass. Two years previously, the patient underwent surgery and radiotherapy for invasive ductal carcinoma of the contralateral breast. The initial appearance of the scar was similar to fat necrosis; it was observed to be progressively shrinking on follow-up sonography. On the two year follow-up ultrasound, the appearance changed, an angular margin and vascularity at the periphery of the scar were noted. A biopsy and subsequent excision of the scar were performed; the diagnosis of infiltrating ductal carcinoma of the scar was confirmed.

Show MeSH
Related in: MedlinePlus