Accessory breast cancer in the inframammary region: a case report and review of the literature

Abstract Background Although a few cases of accessory breast cancer (ABC) have been reported, most were in the axillary region. We encountered an extremely rare case of ABC in the inframammary region (IMR). Case presentation The patient was a 68-year-old postmenopausal woman who had noticed a congen...

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Main Authors: Yuka Eguchi, Heiji Yoshinaka, Naoki Hayashi, Kazunobu Sueyoshi, Keiichiro Uchikura, Yuki Nomoto, Ayako Nagata, Hazuki Saho, Yoshiaki Shinden, Takao Ohtsuka
Format: Article
Language:English
Published: Japan Surgical Society 2021-09-01
Series:Surgical Case Reports
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Online Access:https://doi.org/10.1186/s40792-021-01285-6
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author Yuka Eguchi
Heiji Yoshinaka
Naoki Hayashi
Kazunobu Sueyoshi
Keiichiro Uchikura
Yuki Nomoto
Ayako Nagata
Hazuki Saho
Yoshiaki Shinden
Takao Ohtsuka
author_facet Yuka Eguchi
Heiji Yoshinaka
Naoki Hayashi
Kazunobu Sueyoshi
Keiichiro Uchikura
Yuki Nomoto
Ayako Nagata
Hazuki Saho
Yoshiaki Shinden
Takao Ohtsuka
author_sort Yuka Eguchi
collection DOAJ
description Abstract Background Although a few cases of accessory breast cancer (ABC) have been reported, most were in the axillary region. We encountered an extremely rare case of ABC in the inframammary region (IMR). Case presentation The patient was a 68-year-old postmenopausal woman who had noticed a congenital accessory nipple in her left IMR with slight, occasional discharge 20 years ago. Recently, she noticed a mass under the accessory nipple and visited a nearby clinic; fine-needle aspiration cytology of the mass revealed that it was malignant. She presented to our department 2 weeks after she had noticed the mass. Physical and imaging examinations showed an irregular tumor mass 1.7 × 1.4 × 1.0 cm in size connected to the accessory nipple beneath the left normal breast. Neither distant metastasis nor lymph node swelling was observed. Ultrasound-guided core needle biopsy revealed the mass to be invasive ductal carcinoma. We diagnosed her tumor as ABC in the left IMR; cT1cN0M0: stage IA. Curative wide resection with sentinel node biopsy was performed. Intraoperative evaluation of the frozen section revealed a hot and green ipsilateral axillary lymph node that was free from carcinoma; therefore, nodal dissection was avoided. Histopathological examination including immunochemical staining revealed that the tumor was invasive ductal carcinoma arising from the accessory breast tissue, scirrhous type, 1.7 × 1.4 × 1.0 cm in size, with a solid intraductal component. There was no lymphovascular infiltration, and the surgical margin was 1.5 cm or more. The tumor was estrogen and progesterone receptor-positive, Her2/neu-negative, and had a Ki-67 labeling index of 20%. There was no involvement of the three hot and/or green nodes. The final classification was pT1cN0(sn)M0: stage IA. Letrozole 2.5 mg/day will be administered for 5 years as adjuvant hormonal therapy. Conclusions A cutaneous and/or subcutaneous lesion except for proper breast tissue on the milk line, or mammary ridge from axilla to groin may be an accessory breast tissue. Its serial abnormalities must be worried malignant potential to ductal carcinoma which needs some imaging and pathological examinations for definitive diagnosis and appropriate treatment according to the usual orthotopic breast cancer without delay.
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spelling doaj-art-d699d0e2e47a4e519259a53f6f805c772025-08-20T02:51:15ZengJapan Surgical SocietySurgical Case Reports2198-77932021-09-01711610.1186/s40792-021-01285-6Accessory breast cancer in the inframammary region: a case report and review of the literatureYuka Eguchi0Heiji Yoshinaka1Naoki Hayashi2Kazunobu Sueyoshi3Keiichiro Uchikura4Yuki Nomoto5Ayako Nagata6Hazuki Saho7Yoshiaki Shinden8Takao Ohtsuka9Department of Breast Surgery, Kagoshima City HospitalDepartment of Breast Surgery, Kagoshima City HospitalDepartment of Breast Surgery, Kagoshima City HospitalDepartment of Pathology, Kagoshima City HospitalUchikura ClinicDepartment of Digestive, Breast and Thyroid Surgery, Kagoshima University HospitalDepartment of Digestive, Breast and Thyroid Surgery, Kagoshima University HospitalDepartment of Digestive, Breast and Thyroid Surgery, Kagoshima University HospitalDepartment of Digestive, Breast and Thyroid Surgery, Kagoshima University HospitalDepartment of Digestive, Breast and Thyroid Surgery, Kagoshima University HospitalAbstract Background Although a few cases of accessory breast cancer (ABC) have been reported, most were in the axillary region. We encountered an extremely rare case of ABC in the inframammary region (IMR). Case presentation The patient was a 68-year-old postmenopausal woman who had noticed a congenital accessory nipple in her left IMR with slight, occasional discharge 20 years ago. Recently, she noticed a mass under the accessory nipple and visited a nearby clinic; fine-needle aspiration cytology of the mass revealed that it was malignant. She presented to our department 2 weeks after she had noticed the mass. Physical and imaging examinations showed an irregular tumor mass 1.7 × 1.4 × 1.0 cm in size connected to the accessory nipple beneath the left normal breast. Neither distant metastasis nor lymph node swelling was observed. Ultrasound-guided core needle biopsy revealed the mass to be invasive ductal carcinoma. We diagnosed her tumor as ABC in the left IMR; cT1cN0M0: stage IA. Curative wide resection with sentinel node biopsy was performed. Intraoperative evaluation of the frozen section revealed a hot and green ipsilateral axillary lymph node that was free from carcinoma; therefore, nodal dissection was avoided. Histopathological examination including immunochemical staining revealed that the tumor was invasive ductal carcinoma arising from the accessory breast tissue, scirrhous type, 1.7 × 1.4 × 1.0 cm in size, with a solid intraductal component. There was no lymphovascular infiltration, and the surgical margin was 1.5 cm or more. The tumor was estrogen and progesterone receptor-positive, Her2/neu-negative, and had a Ki-67 labeling index of 20%. There was no involvement of the three hot and/or green nodes. The final classification was pT1cN0(sn)M0: stage IA. Letrozole 2.5 mg/day will be administered for 5 years as adjuvant hormonal therapy. Conclusions A cutaneous and/or subcutaneous lesion except for proper breast tissue on the milk line, or mammary ridge from axilla to groin may be an accessory breast tissue. Its serial abnormalities must be worried malignant potential to ductal carcinoma which needs some imaging and pathological examinations for definitive diagnosis and appropriate treatment according to the usual orthotopic breast cancer without delay.https://doi.org/10.1186/s40792-021-01285-6Accessory breast cancerInframammary regionSentinel node biopsy
spellingShingle Yuka Eguchi
Heiji Yoshinaka
Naoki Hayashi
Kazunobu Sueyoshi
Keiichiro Uchikura
Yuki Nomoto
Ayako Nagata
Hazuki Saho
Yoshiaki Shinden
Takao Ohtsuka
Accessory breast cancer in the inframammary region: a case report and review of the literature
Surgical Case Reports
Accessory breast cancer
Inframammary region
Sentinel node biopsy
title Accessory breast cancer in the inframammary region: a case report and review of the literature
title_full Accessory breast cancer in the inframammary region: a case report and review of the literature
title_fullStr Accessory breast cancer in the inframammary region: a case report and review of the literature
title_full_unstemmed Accessory breast cancer in the inframammary region: a case report and review of the literature
title_short Accessory breast cancer in the inframammary region: a case report and review of the literature
title_sort accessory breast cancer in the inframammary region a case report and review of the literature
topic Accessory breast cancer
Inframammary region
Sentinel node biopsy
url https://doi.org/10.1186/s40792-021-01285-6
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