Breast cancer after prophylactic mastectomy for Lobular Carcinoma-In-Situ (LCIS) - an unusual case

Gurjar, N; Basit, Abdul; Thomson, Catherine S.; Kirby, Robert

doi:10.1093/jscr/2012.10.2

“…There is a 4.3% recurrence rate of carcinoma after modified radical mastectomy. [17][18][19][20][21][22][23][24][25] This case highlights the importance of regular screening with annual mammogram in patients with a history of lobular cancer even more than 10years after bilateral mastectomies. Carcinomas arising in residual breast tissue may behave aggressively, including even those with low grade histology.…”

Section: Following Simple Mastectomy Residual Breast Tissue Is Presentmentioning

confidence: 77%

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2017

ICPJL

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Invasive classic lobular carcinoma represents a risk factor for bilateral lobular as well as ductal breast cancers. Some patients elect to undergo bilateral mastectomies with prophylactic simple mastectomy of the contralateral breast. We report a case of a 63year old female, with history of Stage I right breast invasive lobular carcinoma diagnosed twelve years previously, status post bilateral mastectomies with tram flap placement. She presents with a right chest wall nodule. The chest wall incisional biopsies and right breast tram pedicle needle core biopsies reveal invasive well differentiated ductal carcinoma grade 1 (Nottingham score, 1+2+1=4). The subsequent right tram flap mastectomy shows well differentiated glands extending into the pectoralis major muscle fibers. The tumor measures 4.7cm in the greatest dimension and demonstrates perineural involvement and vessel wall invasion. After bilateral prophylactic mastectomies in patients with BRCA1 and BRCA2 mutations, up to 1.9% develop breast cancer. Invasive breast cancers can arise in small foci of residual breast tissue. Even well differentiated ductal carcinoma can behave aggressively with vascular wall, perineural, and skeletal muscle invasion. The periodic follow up of breast cancer patients even greater than 10 years after bilateral mastectomies is important.

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“…We have planned to subject the patient to radiotherapy to achieve better loco regional control, as the margins of ectopic breast tissue may not be well defined. Gurjar et al 16 reported development of malignancy in axilla 21 months after a patient had undergone prophylactic mastectomy for lobular carcinoma in situ (LCIS). This suggests that remaining normal breast tissue or ectopic breast tissue is still susceptible to development of malignancy.…”

Section: Discussionmentioning

confidence: 99%

Carcinoma in accessory axillary breast

Khanna

¹

,

Mishra²,

Kumar

³

et al. 2015

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We present a rare case of carcinoma developing in an accessory breast. The patient presented with a progressive lump in her right axilla for 1 year. On examination, there was a well-developed nipple areola complex in the right axilla overlying a hard, fixed 5 × 3 cm lump. On investigation, core biopsy revealed poorly differentiated carcinoma of the breast. Mammography also revealed features of a malignant lesion with skin and muscle infiltration. Neoadjuvant chemotherapy was administered followed by modified radical mastectomy after three cycles. Immunohistochemistry study showed positive status of oestrogen and progesterone receptors, and negative HER-2 neu. Three more cycles of chemotherapy along with 50 Gy radiotherapy were given in an adjuvant setting followed by hormone therapy.

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Aggressive Well Differentiated Invasive Ductal Carcinoma Twelve Years after Bilateral Mastectomies for Invasive Lobular Carcinoma

Khan¹,

Zafar²,

Lambert³

et al. 2017

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Invasive classic lobular carcinoma represents a risk factor for bilateral lobular as well as ductal breast cancers. Some patients elect to undergo bilateral mastectomies with prophylactic simple mastectomy of the contralateral breast. We report a case of a 63year old female, with history of Stage I right breast invasive lobular carcinoma diagnosed twelve years previously, status post bilateral mastectomies with tram flap placement. She presents with a right chest wall nodule. The chest wall incisional biopsies and right breast tram pedicle needle core biopsies reveal invasive well differentiated ductal carcinoma grade 1 (Nottingham score, 1+2+1=4). The subsequent right tram flap mastectomy shows well differentiated glands extending into the pectoralis major muscle fibers. The tumor measures 4.7cm in the greatest dimension and demonstrates perineural involvement and vessel wall invasion. After bilateral prophylactic mastectomies in patients with BRCA1 and BRCA2 mutations, up to 1.9% develop breast cancer. Invasive breast cancers can arise in small foci of residual breast tissue. Even well differentiated ductal carcinoma can behave aggressively with vascular wall, perineural, and skeletal muscle invasion. The periodic follow up of breast cancer patients even greater than 10 years after bilateral mastectomies is important.

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Breast cancer after prophylactic mastectomy for Lobular Carcinoma-In-Situ (LCIS) - an unusual case

Cited by 3 publications

References 9 publications

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Carcinoma in accessory axillary breast

Aggressive Well Differentiated Invasive Ductal Carcinoma Twelve Years after Bilateral Mastectomies for Invasive Lobular Carcinoma

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