Inflammatory Breast Carcinoma in a Pre-existing Mammary Hamartoma: A rare case report and Review of Literature

Jitendra Parmar,Tapan Patel,Bhoomi Angirish,Anagha Zope,Sumita Choudhary

doi:10.31579/2690-4861/153

Abstract

Mammary hamartoma is uncommon typically non-malignant benign breast lesion, comprising varying amounts of fatty, fibrous connective tissue and glandular elements. The co-existence of hamartomas and malignancy is very rare and it has no special propensity to undergo malignant transformation. We present a case report of a 66-year-old patient diagnosed with Inflammatory Breast Carcinoma within a previously diagnosed mammary hamartoma in the right breast. The comprehensive work-up with mammography, ultrasound, Positron Emission Tomography – Computed Tomography (PET-CT) and ultrasound-guided biopsy confirmed invasive ductal carcinoma within the hamartoma. Although malignancy arising within hamartoma is an extremely rare entity, the radiologist should be aware and prudent of the atypical as well as suspicious features within hamartoma during interpretation of imaging modalities and should thoroughly investigate any architectural distortion or microcalcifications within an otherwise typical hamartoma. No case has been reported for inflammatory breast carcinoma in mammary hamartoma as per our best of knowledge.

Highlights

Mammary hamartoma, known as fibroadenolipoma is uncommon typically non-malignant benign breast lesion, comprising varying amounts of fatty, fibrous connective tissue and glandular elements
Arrigoni et al reported mammary hamartoma first time in 1971 as a well circumscribed lesions comprising varying amount of benign fat and fibro glandular tissue [1]. He described a classical mammographic findings of a well circumscribed lesion comprising soft tissue density and fat surrounded by a pseudo capsule, which gives a “breast within a breast” or a “cut sausage” appearance [1,2]
Very few case reports have described different types of malignancy including both invasive and non-invasive malignancies arising within hamartomas [5,6,7,8,9]

Summary

Introduction

Known as fibroadenolipoma is uncommon typically non-malignant benign breast lesion, comprising varying amounts of fatty, fibrous connective tissue and glandular elements. On ultrasound (Figure 2), a well-defined and well-circumscribed area of fibro-glandular tissue same as rest of breast parenchyma was seen in outer quadrant of right breast (Figure 3A) Within this area, poorly appreciated, an ill-defined hypoechoic lesion was noted, which was associated with architectural distortion (Figure 3B), and diffuse overlying skin thickening involving more than 1/3rd of breast. PET-CT (Figure 3) was done for staging, which shows mild increased uptake in entire right breast (as compared to left breast) with diffuse overlying skin thickening (more than 1/3rd of the skin of the breast) and nipple retraction It confirmed a well-defined encapsulated fibro glandular tissue same as breast with classical appearance of “Breast within Breast”, suggestive of breast hamartoma (Figure 3A). The case was discussed in multidisciplinary meeting and advised to have neoadjuvant chemotherapy (Docetaxel, Anthracycline and Cyclophosphamide) for 6 cycles followed by surgery and radiation if required

Discussion

Funding and Conflict of Interest