Lactating breast abscess: a rare presentation of adenosquamous breast carcinoma

Alipour S, Seifollahi A, Anbiaee R
Correspondence: Dr Sadaf Alipour, sadafalipour@yahoo.com

ABSTRACT
We report the case of a 33-year-old lactating woman who presented with a 10-cm breast abscess. Biopsy of the abscess wall revealed a poorly differentiated invasive ductal carcinoma. The patient had no family history of breast cancer or other risk factors for breast cancer. The disease was considered to be a large noninflammatory invasive breast cancer, for which the patient received neoadjuvant chemotherapy, breast-conserving surgery using axillary dissection (the patient did not consent to a mastectomy), and postoperative radiotherapy. Final histologic examination revealed a 4-cm, triple negative, high-grade adenosquamous carcinoma. At follow-up four years after surgery, the patient was doing well with no signs of recurrence. Adenosquamous carcinoma is an extremely rare disease that mainly presents in low-grade forms. High-grade forms are aggressive and frequently present with axillary involvement. To the best of our knowledge, there has been no report of adenosquamous carcinoma presenting as a breast abscess in the literature. The case we report highlights that, although rare, cancer should be considered in lactating breast abscesses.

Keywords: abscess, breast, carcinoma
Singapore Med J 2013; 54(12): e247-e249; http://dx.doi.org/10.11622/smedj.2013251

http://smj.org.sg/sites/default/files/5412/5412cr4.pdf

REFERENCES

1. Lee WY, Cheng L, Chang TW. High grade adenosquamous carcinoma of the breast diagnosed by fine needle aspiration cytology. Acta Cytol 1999; 43:323-5. http://dx.doi.org/10.1159/000330992

2. Agrawal A, Saha S, Ellis IO, Bello AM. Adenosquamous carcinoma of breast in a 19 years old woman: a case report. World J Surg Oncol 2010; 8:44. http://dx.doi.org/10.1186/1477-7819-8-44

3. Van Hoeven KH, Drudis T, Cranor ML, Erlandson RA, Rosen PP. Low-grade adenosquamous carcinoma of the breast. A clinocopathologic study of 32 cases with ultrastructural analysis. Am J Surg Pathol 1993; 17:248-58. PMid:8434705

4. Ho BC, Tan HW, Lee VK, Tan PH. Preoperative and intraoperative diagnosis of low-grade adenosquamous carcinoma of the breast: potential diagnostic pitfalls. Histopathology 2006; 49:603-11. http://dx.doi.org/10.1111/j.1365-2559.2006.02524.x

5. Gupta C, Malani AK. Abscess as initial presentation of pure primary squamous cell carcinoma of the breast. Clin Breast Cancer 2006; 7:180. http://dx.doi.org/10.1016/S1526-8209(11)70886-2

6. Damin AP, Nascimento FC, Andreola JB, et al. Primary epidermoid carcinoma of the breast presenting as a breast abscess and sepsis. Sao Paulo Med J 2011; 129:424-7. PMid:22249799

7. Tan YM, Yeo A, Chia KH, Wong CY. Breast abscess as the initial presentation of squamous cell carcinoma of the breast. Eur J Surg Oncol 2002; 28:91-3. http://dx.doi.org/10.1053/ejso.2001.1156

8. Salemis NS. Breast abscess as the initial manifestation of primary pure squamous cell carcinoma: a rare presentation and literature review. Breast Dis 2011; 33:125-31. PMid:22571936

9. Sun LM, Huang EY, Meng FY, et al. Primary breast lymphoma clinically mimicking acute mastitis: a case report. Tumori 2011; 97:233-5. PMid:21617722

10. Antoniou SA, Antoniou GA, Makridis C, Spyrou A, Malkotsi T. Bilateral primary breast lymphoma masquerading as lactating mastitis. Eur J Obstet Gynecol Reprod Biol 2010; 152:111-2. http://dx.doi.org/10.1016/j.ejogrb.2010.05.015

11. Kelten C, Sen Turk N, Kesen Z, Akbulut M, Duzcan E. Fine-needle aspiration biopsy of an invasive ductal carcinoma with medullary features presented with abscess formation. Diagn Cytopathol 2010; 38:624-5. PMid:20082408

12. Kamal RM, Hamed ST, Salem DS. Classification of inflammatory breast disorders and step by step diagnosis. Breast J 2009; 15:367-80. http://dx.doi.org/10.1111/j.1524-4741.2009.00740.x