Intraductal papilloma of ectopic breast tissue in axillary lymph node of a patient with a previous intraductal papilloma of ipsilateral breast: a case report and review of the literature

Radan Dzodic,Tatiana Rogounovitch,Boban Stanojevic,Marko Buta,Momcilo Inic,Ivan Markovic,Masahiro Nakashima,Gordana Pupic,Vladimir Saenko,Shunichi Yamashita

doi:10.1186/1746-1596-5-17

Abstract

The presence of ectopic breast tissue in axillary lymph nodes (ALN) is a benign condition that must be differentiated from primary or metastatic carcinoma. Here we report a patient who underwent excision of enlarged ALN 10 years after she had received surgical treatment of ipsilateral breast for an intracystic intraductal papilloma (IDP). Histological examination of the removed ALN revealed that the proliferative lesion consisted of papillary and tubular structures lined by luminal cuboidal cells and a distinct outer layer of myoepithelial cells resembling IDP of the breast. Immunostaining with a set of immunohistochemical markers including AE/AE3, alpha-smooth muscle actin and p63 in combination with estrogen and progesterone receptors confirmed the diagnosis of ectopic IDP.This case shows that even though benign proliferative change in ectopic breast tissue is an extremely rare phenomenon, this possibility should be taken into account for correct diagnosis.

Highlights

Metastasis of breast cancer is most frequently found in axillary lymph nodes (ALN) [1]
In this report we present a case intraductal papilloma (IDP) in ALN of a patient who had been treated for IDP of the breast 10 years before
The phenomenon of intranodal glandular inclusions in ALN attracts the attention of breast surgeons and pathologists since their presence may be mistaken for primary or metastatic carcinoma

Summary

Background

Metastasis of breast cancer is most frequently found in axillary lymph nodes (ALN) [1]. The presence of ectopic breast tissue (EBT) due to embryological displacement within ALN is an uncommon but well-recognized phenomenon [2]. The presence of a benign proliferative lesion arising in ectopic duct epithelium is exceptionally rare [3]. Necrosis or cells with atypical features were detected, suggesting the benign nature of the neoplasm. Both the proliferative papillary lesion and small clusters of duct-like structures were observed in the lymphoid tissue surrounding the cystic area (Figure 2C and 2D). The presented case was diagnosed as IDP of ectopic breast tissue in ALN on the basis of histopathological and immunohistochemical findings. Eight years after ALN excision, the patient was in excellent condition without any signs of recurrence

Discussion

Conclusion