The rare entity of contra-lateral axillary lymph node metastasis(CAM) has been a debatable topic in the realm of breast cancer management for many years. There remains controversy over whether CAM should be considered distant metastasis or locoregional spread. It is also uncertain why or how CAM occurs. In this case report and review of the literature, we present an 81-year-old female with an apparent second primary breast cancer with synchronous CAM. This paper describes a scenario of altered lymphatic drainage which likely lead to CAM. In this situation, we propose that CAM should be treated with curative intent rather than stage IV disease. We also attempted to gain a better understanding of the histopathology and tumor characteristics of tumors associated with CAM. Our patient was treated with curative intent and remains disease free for over 18 months. This supports the theory that patients with distorted lymphatic drainage from prior interventions who have CAM, should be treated as locoregional extension of the disease.

HighlightsRosai-Dorfman Disease is a benign disease of cervical adenopathy.Extranodal disease can present rarely in the breast.Histiocytes with emperipolesis is the hallmark pathological finding.Surgical excision with post-op observation is the treatment for breast lesions.Minimal amount of cases found in the male breast.

HighlightsMetastatic breast carcinoma rarely spreads to the Gastrointestinal Tract (GIT).GIT breast carcinoma rarely has triple: ER, PR and HER2-neu negative histology.We report a case of triple negative breast carcinoma that spread to the jejunum.This is the first reported case in the U.S.

terial, samples are strongly S-100 protein reactive. Secretory breast carcinoma is driven by the fusion gene ETV6-NTRK3 that results from a balanced translocation t (12; 15) [6].Fortunately for most diagnosed with SBC, the course is indolent even in the setting of nodal metastasis, which is present in 15-35% cases at presentation [2,3,7]. Although distant metastasis is very rare, local recurrence is described, recurring as far as 16 years after treatment [8]. At present the primary treatment remains surgical. Case ReportA 75-year-old female presented to our clinic with complaint of new onset right nipple pain and swelling for 4 weeks. Family history was significant for breast cancer in a maternal and a paternal first cousin, as well as a maternal aunt who succumbed to her disease at age 50. The initial physical exam revealed a tender, erythematous, enlarged right nipple, but no palpable masses. The initial impression was mastitis, and she was started on azithromycin. A diagnostic mammogram showed asymmetry of the right nipple compared to the left ( Figure 1), however, ultrasound at that time was unremarkable. Her symptoms did not improve with antibiotics.A repeat targeted ultrasound of this area revealed an abnormal right nipple complex (Figure 2). She was then assessed by a breast surgeon, and the exam at that time revealed a firm, tender, erythematous mass of the superior aspect of the right nipple, and a palpable right axillary lymph node. Ultrasound-guided fine needle aspiration biopsy of the axillary node was consistent with metastatic adenocarcinoma. The tumor stained positive AbstractSince first being noted in the literature in 1966, Secretory Breast Carcinoma (SBC) continues to be better defined in terms of its clinical, histologic, and genetic features. However, its unique presentation can elude seasoned practitioners from making a clinical diagnosis. Furthermore, there is neither consensus nor guidelines as to the optimal treatment approach for SBC. We are presenting this case report and literature review to raise awareness about SBC by demonstrating how uniquely this pathology can present itself, to summarize the current literature, and to present our specific approach to this rare cancer.

HighlightsRosai-Dorfman Disease of the breast is a benign disease with minimal cases.Pseudoangiomatous stromal hyperplasia is a benign pathological finding that can be found in men with gynecomastia.Asymptomatic recurrent Rosai-Dorfman Disease conservatively managed by observation.First recurrent male case of Rosai-Dorfman Disease.First case of Rosai-Dorfman Disease associated with pseudoangiomatous stromal hyperplasia.

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