Invasive Ductal Carcinoma Arising from Axillary Accessory Breast Tae Wan Kim, Sang Wook Kang, Ji Young Park 2, Seung Sang Ko 1, Min Hee Hur 1, Hae Kyung Lee 1, Sung Soo Kang 1, and Jee Hyun Lee 1 Department of Surgery, Yonsei University College of Medicine, Departments of 1 Surgery and 2 Pathology, Samsung Cheil Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea As a consequence of the incomplete resolution of embryologic mammary ridges, ectopic breast tissue can be present anywhere along the "milk line", including the axillary region. Aberrant breast tissue can develop with any disease that affects the normal breast, including a breast carcinoma. A carcinoma of aberrant breast tissue is rare, but should still be investigated and treated properly with respect to other breast cancers in the embryonic milk-line. Herein is reported our recent experience of a carcinoma originating from aberrant breast tissue in the right axilla. An abnormal nodule around the periphery of the normal breast should be suspected as a breast carcinoma and differential diagnosis and properly treated. (Journal of Korean Breast Cancer Society 2004;7:306-310) Key Words: Axillary accessory breast, Aberrant breast tissue, Breast cancer :,
김태완 외 액와부 부유방에서 생긴 침윤성 유관암 307 ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ A B C Fig. 1. Serial comparison of film mammography on right breast (medio-latero-oblique view only). A. 2001 November: Moderate to dense fibroglandular density. Benign calcification, No separable mass. Impression; No evidence of malignancy. B. 2003 July: About 1cm sized relatively well marginated nodule is seen on right upper outer area, axillary tail. Impression; Benign calcifications on both breasts. More likely benign nodule on right axillary tail area (Category 3). C. 2004 January: As comparing to previous mammogram (Fig. 1), previously demonstrated right axillary tail located nodule is much enlarged in size with lobulated contour. And also dense lymph nodes are seen on right axilla. Impression; Possibility of right axillary tail malignancy with axillary lymph node metastasis, suspected (Category 4-5). vasive ductal carcinoma, NOS, axillary node: 6/32)이었고 (Fig. 5) Estrogen Receptor (ER), Progesterone Receptor (PR), 그리고 p53은 음성이었으며 c-erb-b2(hercep test) 는 2+였다. 현재 환자는 보조적 항암 화학 요법(AT 2 2 regimen; Adriamycin 50 mg/m +Taxotere 75 mg/m -6 cycle)과 중간(3 cycle 후)에 방사선 치료를 시행 받았으 며 현재 재발 없이 정기 추적관찰 중이다. 고 Fig. 2. Finding of physical examination. The circle indicate the lesion of right axillary area. (Fig. 4). 즉시 시행한 중심침 조직 생검에서 침윤성 유관암으 로 보고되어, 액와부 부유방에서 발생한 암 진단하에 액와부 부유방을 포함한 우외측 부분유방절제술 및 액 와부 림프절 곽청술을 시행받았다. 수술 후 병리 조직 검사 결과는 병기 IIIA (T2N2M0)의 침윤성 유관암(In- 찰 부유방의 발생 빈도는 정확히 알려져 있지 않고, 보 고자마다 차이가 있으나 대체로 성인 여성의 1 6% 정 도로 보고되고 있다.(1,2) 태아발생 7주와 8주 사이에 외배엽성 원시 유선이 태아의 액와부에서 서혜부 사이 에 발생하며 태아발생 10주와 14주 사이에, 흉부 외 부 위의 유선은 퇴화하는데 이 시기의 불완전한 퇴화 또 는 원시 유선의 과도한 분산이 부유방의 형성을 유도 한다.(2,4,5) 따라서 부유방은 원시 유선을 따라 액와부 에서 서혜부에 걸쳐 어디에나 발생할 수 있으며 남자 에서도 발생할 수 있고, 드물게는 대퇴부나 음부 등에 서도 발생할 수 있지만, 주로 사춘기 이후에 액와부에 서 관찰된다.(6,7)
308 한국유방암학회지 제 7 권 제 4 호 2004 ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ Fig. 3. Finding of film mammography. Previously demonstrated right axillary tail located nodule is much enlarged in size with lobulated contour. And also dense lymph nodes are seen on right axilla. Left axillary focal increased parenchymal densities are also seen. Underlying diffuse increased parenchymal densities are seen on both breasts with nodularities. Both benign calcifications are seen. Others are unremarkable. Impression; Possibility of right axillary tail malignancy with axillary lymph node metastasis, suspected. 2. Both benign calcifications (Category 4-5). Fig. 4. Finding of ultrasonography. About 20.9 18.6 16.7 mm sized lobulated hypoechoic nodule with inhomogenous internal echo is noted on right axilla. Two enlarged lymph nodes with cortical thickening, 16.7 mm and 9.3 mm, are noted on right axilla, level I. Others are not remarkable. Impression) Highly suspicious mlaignancy, right axillary accessory breast with lymph nodes metastasis (Category 4-5).