Hindawi Publishing Corporation

Case Reports in Pathology
Volume 2016, Article ID 3603262, 4 pages
http://dx.doi.org/10.1155/2016/3603262

Case Report
A Nonpalpable Nodule in Ectopic Axillary Breast Tissue:
Consider Phyllodes Tumor

Eva Ruvalcaba-Limón,1 Verónica Bautista-Piña,2 Julio Ramírez-Bollas,1
Ruby Espejo-Fonseca,3 and Sergio Rodríguez-Cuevas1
1
Department of Breast Surgical Oncology, Instituto de Enfermedades de la Mama y Fundación del Cáncer de Mama (IEM-FUCAM),
Mexico City, Mexico
2
Department of Pathology, IEM-FUCAM, Mexico City, Mexico
3
Department of Radiology, IEM-FUCAM, Mexico City, Mexico

Correspondence should be addressed to Eva Ruvalcaba-Limón; evaruvalcaba@yahoo.com.mx

Received 30 July 2016; Revised 23 November 2016; Accepted 7 December 2016

Academic Editor: Janina Kulka

Copyright © 2016 Eva Ruvalcaba-Limón et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.

Benign and malignant pathology can develop in ectopic axillary breast tissue, such as fibroadenomas, phyllodes tumors, and breast
cancer. We present a rare case of an asymptomatic 43-year-old woman with an axillary nodule which was identified during screening
mammography within ectopic axillary breast tissue, initially considered as a suspicious lymph node. Radiologic studies were
considered as Breast Imaging-Reporting Data System (BI-RADS) 4. A hyperdense, lobular, and well-circumscribed nodule was
identified in mammogram while the nodule by ultrasound (US) was hypoechoic with indistinct microlobular margins, without
vascularity by Doppler, and measuring 1.26 × 1 cm. Core-needle biopsy reported a fibroepithelial neoplasm. The patient was
submitted to local wide-needle excision located in intraoperative radiography of the surgical specimen and margin evaluation.
Final histopathological study reported a 1.8 × 1.2 cm benign phyllodes tumor, with irregular, pushing, and clear wide margins
within normal ectopic breast tissue. The patient without surgical complications continued annual screening without recurrence
during a follow-up that took place 24 months later.

1. Introduction the pregnancies. At her first screening mammography at a
mobile unit, a nodule was identified on the left axillary.
Benign and malignant pathology can develop in breast tissue, Mammography findings were diagnosed as Breast Imaging-
even if the mammary tissue is localized in ectopic foci in the Reporting Data System (BI-RADS) 4 due to the presence
axillary area. Benign pathology can identify fibroadenomas of a hyperdense, lobular, and well-circumscribed nodule,
[1, 2], as well as malignant disease such as breast cancer [3, 4]. suggested as a suspicious lymph node (Figure 1). By ultra-
The presence of nodules in axillary breast tissue is extremely sound (US) imaging, hypoechoic nodule measuring 1.26 ×
rare, and they are usually confused with axillary lymph nodes. 1 cm was identified, with indistinct microlobular margins and
without vascularity identified by Doppler (Figure 2). During
2. Case Presentation physical exploration, there was only the presence of bilateral
ectopic axillary breast tissue with a volume of 8 × 8 cm,
This is a case of a 43 years old woman who had systemic without palpable lumps in the patient’s mammary glands
high blood pressure, multiparous with three pregnancies and or in the ectopic tissue. The histopathological study from
three vaginal deliveries, with positive breastfeeding after 1 the US-guided core-needle biopsy revealed a fibroepithelial
year on each birth. She has not used hormone contraception; neoplasm. The patient underwent wide-needle localized exci-
body mass index was 26.3 kg/m2 , and there was bilateral sion with intraoperative radiography of surgical specimen
ectopic axillary breast tissue that increased in volume after (Figures 3(a) and 3(b)) and evaluation of tumor margins by

and one mitosis per gross description reported a round multinodular soft mass. and well-circumscribed nodule in ectopic axillary breast tissue in digital mammographic study. screening without recurrence during a follow-up that took tion in low-power views showed a fibroepithelial lesion with place 24 months later.2 cm in dimension. lobular.2 Case Reports in Pathology Figure 1: Nonpalpable hyperdense. mild cell atypia. Figure 2: Hypoechoic nodule with indistinct microlobular margins and without vascularity in US study. tumor demonstrated a white with florid hyperplasia were present (Figures 5(a) and 5(b)). the pathologist. the presence of benign phyllodes tumor with clear wide infiltrating focal borders. . Epithelial and benign glandular elements 1. (a) (b) Figure 3: Wide-needle localized excision (a) with intraoperative radiography of surgical specimen (b).8 × 1. The microscopic descrip. focal The patient without surgical complications continued annual with irregular borders (Figure 4). The final histopathological study reported intracanalicular growth patterns that form cleft-like spaces. The and hypercellular areas. cut surface and well-circumscribed lobulated contours. stromal heterogeneity with myxoid margins (>10 mm) in a normal ectopic breast tissue. 10 high-power field.

even this phyllodes tumor was in uncommon margins is mandatory. 11] The authors declare that there is no conflict of interests but. “Fibroadenoma of ectopic axillary breast The main differential diagnosis is fibroadenoma which tissue: report of three cases and review of the literature. the pathologist needs to analyze the whole surgical gland. programs. these could increase to 31% [12]. pp. and those that grow from ectopic breast tissue ders must be differentiated from periductal stromal sarcoma. inframammary. asymptomatic phyllodes tumors were documented in 8. as well as the three. no. and vulvar). morphology remains tumors [6–8]. (a) (b) Figure 5: (a. have limited value in differential diagnosis of fibroepithelial such as fibroadenomas [1.” Gine- is especially difficult on core biopsies.1% (25/307 cases) during a 10-year period. it could growth pattern and is composed of multiple nodules sepa- develop any benign and/or malignant disease [5]. M. Nonpalpable mammary lesions could be submit- ted to needle-guided excisional biopsy with intraoperative evaluation of the surgical specimen. or malignant phyllodes other nonpalpable phyllodes tumors in normal mammary tumor. Discussion phyllodes tumor diagnosis included increased stromal cellu- larity. the stroma is mildly atypical with one mitosis per 10 high-power field. . in geographical settings with breast cancer screening regarding the publication of this paper. are extremely rare. stromal overgrowth. As in our case phyllodes tumor with infiltrating bor- uncommon. borderline. Wherever the localization of ectopic breast the main histologic features is that the last one lacks a leaf-like tissue (axillary. 2. At our institute.Case Reports in Pathology 3 Figure 4: A 1. Parameters favoring cologı́a y Obstetricia de México. pleomorphism. There rated by nonneoplastic tissue. 2] or less commonly phyllodes neoplasms. b) H&E ×10 intracanalicular pattern forming cleft-like spaces.3%). vol. with well-circumscribed lobulated contours. and presence of Asymptomatic cases with phyllodes tumor of the breast is mitoses. crude. 99–103. despite the research efforts. diagnosis and treatment are similar to those in To classify benign. specimen. focal with irregular borders.2 cm round multinodular soft mass. [1] C. localization. Diagnosis should be performed with core. Ortiz-Mendoza. 2012. Competing Interests dimensional margins to ensure wide margins [9]. and treatment with surgical excision with wide However. and only one case was References localized in axillary tissue (0. the gold standard for the diagnosis of these tumors. 80. Immunohistochemistry stains are few cases of fibroepithelial neoplasm localized in axilla.8 × 1. 3. Very small phyllodes tumors are reported in fewer than 10% [10. needle biopsy.

E. C. 114. Aggon. R.” The American Journal of Case Reports. Friedman.. J. Yamamoto et al.-K. Boraas. vol. 214–220. J. W. [9] E. H. 153–159. [5] V. H. J. Velanovich. J. vol. [10] M. 1990. 3. R. no. no. pp. Pérez. “Cystosarcoma phyllodes arising synchronously in right breast and bilateral axillary ectopic breast tissue. L. pp. Kim. pp. “Primary phyllodes tumor of the axilla: DCE-MRI findings with 1. and H. 6. 1. 42. 70. “Lobular carcinoma in ectopic axillary breast tissue. Klein. pp. 88. 312–315. 1995. H. . 793–795. Oh. D. pp. R. “Phyllodes tumor arising in ectopic breast tissue of the axilla. and D. 525–527. 2015. S. pp. Kim. vol. pp. E. B. pp. vol. no. Kulkarni. M. Miyauchi. Sánchez. Seo. no. no. 6. supernumerary breasts. I. “Phyllodes tumor of the breast: clinicopatho- logic analysis of 22 cases. “Giant fibroadenoma in the axilla: a common entity of uncommon size in a rare location.” Archives of Plastic Surgery. “Ectopic breast tissue.” Archives of Pathology and Laboratory Medicine. and E. M. 2011. and R. vol. Nardello. Medina-Franco. F. Bohle. A. M. 624–626.-A. E. 59. E. 185–190. 65. Hernández. N. “Phyllodes tumor diagnosed after ultrasound-guided vacuum- assisted excision: should it be followed by surgical excision?” Ultrasound in Medicine and Biology. Gamboa-Domı́nguez.. [3] S. G. “Radiological con- trol intraoperatory of a surgical piece in non palpable breast lesions. no. Piña et al. A. T.” American Surgeon. 2007. 2013. Bleicher. Kim. 3. S. Youk. vol. Son. 2015.” Revista de Investigación Clı́nica. 16. 41. 9. pp.” Southern Medical Journal. [7] H. and supernumerary nipples. 2015.. Petrillo. vol. 2009. Feldman. 2004. M. no. M. Y. 10. Poblete. Giron. vol. Petrillo. and J.” Revista Chilena de Cirugı́a. vol. M. [12] J. and S. vol.” Breast Cancer. pp. O. Park. 9. [11] P. Massri. 903–906. no. 82–84. no.4 Case Reports in Pathology [2] B. 407–418. Sigurd- son. vol. A.” Ginecologı́a y Obstetricia de México. “Tumor filodes de la mama. no. [4] G. J. Fulciniti et al. 3. Kim.” The Breast Journal. E. V. N. Oshida. [6] A. Fonseca. Velázquez-Dohorn. H. 77. A. F. [8] K. Limón. M. Caracterización clı́nica e histopatológica de 39 casos.5T breast-dedi- cated system and pathological correlation. 5. 2003. pp. Saleh and L. “Invasive mucinous carcinoma arising in ectopic axillary breast tissue: a case report and literature review. 17. 4. 741–747.