Cardiothoracic Surgery Unit, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Plastic Surgery Unit, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Histopathology Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
BACKGROUND: Papillary carcinoma of the breast is a rare malignant tumour accounting for 1% - 2% of all breast cancers in women. Papillary carcinomas of the chest wall are always secondary to thyroid, thymus and ovaries. Other variants of breast cancer metastasizing to the chest wall have been reported. CASE: We report a 67-year-old woman presented to us with an ulcerated anterior chest wall mass of 1-year duration, bilateral axillary, supraclavicular and cervical swellings of 8-month duration. There was a history of breast lump which was noticed 5 years prior to presentation, no history of breast malignancy in the past and no family history of breast cancer. Examination revealed an ulcerated, nodular mass over the sternal angle which measured 14 cm × 12 cm × 4 cm; she had bilateral axillary, supraclavicular and cervical lymphadenopathy which were non-tender and matted. She had a firm, non-tender right breast lump measuring 6 cm × 4 cm. Chest examination and abdominal examinations were essentially normal. Chest X-ray revealed erosion of sternal bone without any evidence of intrathoracic extension. Abdominal ultrasound and thyroid scans were normal. Histology of the mass revealed papillary carcinoma. Biopsy of the right breast also revealed papillary carcinoma. She had excision of the fungating tumour and primary closure of defect. She subsequently had combination chemotherapy using ondasetron, cyclophosphamide, adriamycin and cisplantin. CONCLUSION: Papillary carcinoma of the breast is rare and rarely metastasizes to the chest wall. The diagnosis of metastatic chest wall tumour requires meticulous history taking, clinical examination and relevant investigations to ascertain the primary origin of the carcinoma.
Abubakar, U. , Legbo, J. , Sahabi, S. , Opara, C. , Jamalu, I. , Musa, N. and Aliyu, S. (2014) Advanced Papillary Carcinoma of the Breast Presenting as an Ulcerated Anterior Chest Wall Tumour: Case Report. Advances in Breast Cancer Research, 3, 1-4. doi: 10.4236/abcr.2014.31001.
[1] M. Muttarak, A. Somwangprasert and B. Chaiwum, “Intracystic Papillary Carcinoma of the Breast,” Biomedical Imaging and Intervention Journal, Vol. 1, No. 1, 2005, p. e5. http://dx.doi.org/10. 2349/biij.1.1.e5 [2] R. Arora, R. Gupta, A. Sharma, et al., “Invasive Papillary Carcinoma of Male Breast,” Indian Journal of Pathology and Microbiology, Vol. 53, No. 1, 2010, pp. 135-137. http://dx.doi.org/10.4103/0377-4929.59206 [3] Y. A. Karamustafaoglu and Y. A. Yoruk, “Chest Wall Distant Metastases of Thyroid Carcinoma,” Trakya üniversitesi Tip Fakültesi Dergisi, Vol. 26, No. 4, 2009, pp. 338-341. [4] J. Krishnamurthy and K. N. Divya, “The Cytology of Subcutaneous Chest Wall Metastasis Originating from Bronchiolo-Alveolar Carcinoma,” Iranian Journal of Pathology, Vol. 6, No. 4, 2011, pp. 212-215. [5] F. Antonia, N. Rosete, F. Diva, et al., “Papillary Adenocarcinoma of the Thymus: Case Report and Review of the Literature,” International Journal of Surgical Pathology, Vol. 18, No. 6, 2010, pp. 530-533. [6] S. H. Yil, S. C. Ho and H. B. Joong, “Chest Wall Metastasis from Unknown Primary Site of Hepatocellular Carcinoma,” World Journal of Gastroenterology, Vol. 12, No. 13, 2006, pp. 2139-2142. [7] C. A. Pascuzzi, D. C. Dahlin and O. T. Clagett, “Primary tumors of the Ribs and Sternum,” Surgery, Gynecology & Obstetics, Vol. 104, No. 4, 1957, pp. 309-400. [8] B. A. Ozuslu, G. Onur, G. Sedat, et al., “Chest Wall Tumour,” Asian Cardiovascular and Thoracic Annals, Vol. 6, No. 3, 1998, pp. 212-215. http://dx.doi.org/10.1177/021849239800600314 [9] D. Carter, S. L. Orr and M. J. Merino, “Intracystic Papillary Carcinoma of the Breast. After Mastectomy, Radiotherapy or Excisional Biopsy Alone,” Cancer, Vol. 52, No. 1, 1983, pp. 14-19.
http://dx.doi.org/10.1002/1097-0142(19830701)52:1<14::AID-CNCR2820520104>3.0.CO;2-N [10] R. Laszlo Jr, M. Emmet O’Brien and R. Norma, “Intracystic Papillary Carcinoma in a Male as a Rare Presentation of Breast Cancer: A Case Report and Literature Review,” Journal of Medical Case Reports, Vol. 3, 2009, p. 13. http://dx.doi.org/10.1186/1752-1947-3-13 [11] Y. Miwa, M. Yukako and Y. Sohei, “Intracystic Invasive Papillary Carcinoma of the Male Breast with Analyses of Loss of Heterozygousity on Chromosome 16q,” Breast Cancer, Vol. 17, No. 2, 2010, pp. 146-159. http://dx.doi.org/10.1007/s12282-009-0101-4 [12] A. E. Wagner, P. M. Lavinia and J. W. Gary, “Intracystic Papillary Carcinoma of the Breast with Invasion,” AJR, Vol. 183, No. 5, 2004, p. 1516. http://dx.doi.org/10.2214/ajr.183.5.1831516