Lactating breast abscess: a rare presentation of adenosquamous breast carcinoma

Abstract

C a s e R e p o r t e247 I NTRO D U C TIO NInflammatory disorders of the breast, including mastitis and breast abscesses, are generally benign diseases that rarely harbour malignancy. Although the occurrence of cancer is not anticipated in true breast abscesses in nursing mothers, it can occasionally happen. Herein, we present a rare case of adenosquamous carcinoma of the breast in a 33-year-old lactating woman who presented with a breast abscess. CA S E R EPO RTA 33-year-old lactating woman presented to our breast clinic with signs of inflammation in her left breast -the skin was largely erythematous and warm over a tender 10-cm fluctuating mass, and several soft, non-suspicious lymphadenopathies were observed in the left axilla. According to the patient, the inflammation began two months prior to presentation and temporarily subsided with the use of oral antibiotics; when the use of oral antibiotics was discontinued, the inflammation flared up. Ultrasonography performed one month prior to presentation showed a multiloculated 93-mm × 82-mm × 63-mm fluidcontaining cavity in the left breast, which was suggestive of a breast abscess, and large reactive axillary lymph nodes in the same side.Intravenous antibiotics were prescribed, lactation ceased, and the cavity was surgically drained, yielding more than 300 mL of diluted pus. As routinely done in our institution, multiple biopsies were performed using the tissue obtained from the abscess wall. of the chest, abdomen and pelvis, and a bone scan of the whole body, was negative. The patient had no family history of breast cancer, and no other known risk factor was detected.Before proceeding with cancer treatment, we had to first determine whether the abscess was an inflammatory carcinoma or an invasive noninflammatory carcinoma presenting as an abscess. Although the inflammatory signs of the breast were in favour of the former diagnosis, a mismanaged large and persistent breast abscess is not uncommon in milk-laden breasts. Hence, the possibility of a lactating abscess superimposed on a typical invasive tumour was considered. However, since the pathologist who reviewed the histology slides could not detect any cancerous involvement in the dermal lymphatics, it was decided that the disease would be treated as a large noninflammatory invasive breast cancer.Following the diagnosis, the surgical wound was immediately closed to allow rapid initiation of neoadjuvant chemotherapy, which involved four cycles of treatment with cyclophosphamide, epirubicin and 5-fluorouracil, followed by four cycles of treatment with taxotere. As the patient did not consent to a mastectomy, breast-conserving surgery with a wide normal margin and axillary dissection was performed. The postoperative course was uneventful. Postoperative radiotherapy consisted of a 5,000-cGy breast and regional lymphatic area irradiation and a 1,000-cGy irradiation boost to the tumour bed. ABSTRACT We report the case of a 33-year-old lactating woman who presented with a 10-cm breast abscess.Biopsy of the abscess w...

Bilateral synchronous low-grade adenosquamous carcinoma of the breast: A Case report with review of the current literature

“…A total of 18 manuscripts (1987 to present) describing 109 cases of LGASC are summarized in Table 1 [1–18] . Patients’ ages range from 19 to 88, with two cases of bilateral LGASC being reported.…”

Breast Abscessed Cancer in Nonlactating Women in Tropical Environment: Radiological, Bacteriological, and Anatomopathological Features about 3 Cases

“…These are most often cases of pure primary squamous cell carcinoma of the breast [15–18] but also primary lymphoma [18, 19] or even lymphoepithelioma-like carcinoma originally presented as an abscess, although it is very rare [20]. Even in breastfeeding an abscess may turn out to be cancer [21]. A real breast cancer can hide behind a typical breast abscess.…”

Inflammatory breast cancer: a clinical diagnosis

“…Singapore Med J 2014; 55(3): 170 doi:10.11622/smedj.2014043 I read the case report "Lactating breast abscess: a rare presentation of adenosquamous breast carcinoma" by Alipour et al (1) with great interest. The authors presented an interesting case of breast cancer in a lactating woman who presented with a longstanding breast abscess of two months' duration.…”