Cutaneous rosai dorfman disease: A case report and literature review

Abstract

adenosis (AMGA) then to ductal carcinoma has been documented in case reports and series. [1][2][3][4][5][6] We report here the first case of AMGA and residual invasive ductal carcinoma in the context of post-neoadjuvant chemotherapy. Case/Methods/Results: A 57-year-old female presented with a 70×55 mm left breast lump. Her medical history included hysterectomy and bilateral oophorectomy for dysfunctional uterine bleeding and fibroid uterus. A breast needle core biopsy showed invasive carcinoma of no special type with areas of high grade ductal carcinoma in situ. Focal areas of MGA were noted. The tumour was ER-, HER2-and PR+(30%). A left axillary lymph node fine needle aspirate showed cohesive fragments of malignant epithelial cells consistent with metastatic carcinoma. The patient was initially treated with neoadjuvant chemotherapy (adriamycin, cyclophosphamide and docetaxel). The breast lump reduced in size to 10 mm in maximum dimension. Following review with a breast surgeon she underwent a left total mastectomy and axillary clearance. Macroscopic examination of the breast specimen revealed an ill-defined nodular area measuring 80 mm in maximum dimension. Microscopically there was an atypical glandular proliferation with glands arranged haphazardly in fibrous stroma and fat. The glands showed a range of proliferative changes with areas of solid and cribriform architecture. These changes were consistent with a spectrum ranging from MGA to AMGA and ductal carcinoma in situ. The glands were devoid of a myoepithelial layer on immunoperoxidase stains. A 12 mm foci of invasive carcinoma in the form of nests and cords without tubule formation was also present which was similar to the initial core biopsy. All seventeen lymph nodes were negative for malignancy. Discussion: Microglandular glandular adenosis is an uncommon benign proliferative glandular lesion. Case studies have shown that carcinoma arises in cases of MGA 1,3-6 and there is molecular evidence of its progression to malignancy. 7 What is unclear are the effects of chemotherapy on MGA. We report here the first case of atypical MGA in the context of post-neoadjuvant chemotherapy.