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

IF 3.3 4区 医学 Q2 ONCOLOGY
Saleh Busbait, Abdullah M. Alkhalifa, Shahad A. Aljohani, Hiyam Alhaddad
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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.
隐匿性侵袭性小叶癌以腋窝皮肤转移病灶为表现,经新辅助内分泌治疗及手术切除:1例报告及文献复习
浸润性小叶癌(ILC)是第二常见的乳腺癌类型,占所有乳腺癌病例的5-15%。它通常表现为非特异性体征和症状。隐匿性乳腺癌表现为腋窝肿块是罕见的,患病率为0.3-1%,不太可能以孤立的皮肤乳腺转移为首次表现。文献中关于接受内分泌治疗和完全手术切除的患者的资料有限。一名54岁女性左腋窝皮肤肿胀持续6年,18个月前诊断为ILC,腋窝皮肤病变溃疡,由于雌激素受体(ER)和孕激素受体(PR)阳性,在另一家医院接受来曲唑治疗。她接受来曲唑治疗18个月,溃疡愈合并出现持续的皮下结节。她的乳房x光片、超声和磁共振成像结果一般;左侧腋窝淋巴结未见明显。左腋窝淋巴结活检呈恶性肿瘤,符合ILC。腋窝皮肤病变的皮肤穿刺活检显示ILC延伸至真皮层,无背景乳腺组织。患者行左侧改良乳房根治术,切除左腋窝皮肤病变。乳腺标本包括0.4 mm的ILC为原发恶性肿瘤和9个阳性腋窝淋巴结恶性肿瘤。患者接受辅助放疗并继续接受来曲唑治疗。随访期间无并发症及复发迹象。结论腋窝溃疡性皮肤病变应引起乳腺癌转移的关注。在孤立的皮肤乳腺转移病例中,手术切除可考虑与内分泌治疗相结合。
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来源期刊
CiteScore
4.10
自引率
0.00%
发文量
40
审稿时长
16 weeks
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